<iii^.iu^ism*<'vr<ii' 


iD  TREATMENT'  OF 
PSYCHOPATHIC  DISEASES 


SIDIS 


UNIVERSITY  OF  CALIFORNIA 
AT   LOS  ANGELES 


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Digitized  by  the  Internet  Archive 

in  2007  with  funding  from 

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http://www.archive.org/details/causationtreatmeOOsidiiala 


THE  CAUSATION  AND  TREATMENT 
OF  PSYCHOPATHIC  DISEASES 


WORKS  BY  BORIS  SIDIS 

The  Foundations  of  Normal  and  Abnormal 
Psychology 

Symptomatology,    Psychognosis,   and  Diag- 
nosis of  Psychopathic  Diseases 

The  Causation  and  Treatment   of   Psycho- 
pathic Diseases 

The  Psychology  of  Suggestion 

Multiple  Personality 

Psychopathological  Researches 

An  Experimental  Study  of  Sleep 

A  Study  of  Galvanometric  Deflections 

The  Nature  and  Causation  of  the  Galvanic 
Phenomenon 

Philistine  and  Genius 

The  Psychology  of  Laughter 


The  Causation  andTreatment 
of  Psychopathic  Diseases 


BY 


BORIS  SIDIS,  A.M., Ph.D., M.D. 

Medical  Director  of 
The  Sidis  Psychotherapeutic  Institute 


BOSTON:  RICHARD  G.  BADGER 

TORONTO:  THE    COPP   CLARK  CO.,  LIMITED 


Copyright,  1916,  by  Boris  Sidis 
All  Rights  Reserved. 


MADE  IN  THE  UNITED  STATES  OF  AMERICA. 

The  Gorham  Press,  Boston,  U.  S.  A. 


WM 
loo 

nit 


Felix  qui  potuit  rerum  cognoscere  causas, 
Atque  metus  omneSj  et  inexorahile  fatum, 
Subjecit  pedibus,  strepitumque  J  c  her  otitis  avari. 

FergiliuSf  Georgica, 

Hunc  igitur  terrorem  animi  tenebrasque  necessest 
Non  radii  solis  neque  lucida  tela  diei 
Discutiant,  sed  naturae  species  ratioque. 

Lucretius  J  De  Rerum  Natura. 


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INTRODUCTION 

Psychopathic  diseases  are  not  hereditary — they  are 
acquired  characteristics.  "Weak  nerves,"  "a  run  down, 
exhausted  nervous  system, "  whatever  the  terms  may 
mean,  may  overlap  psychopathic  conditions,  but  the 
two  are  by  no  means  equivalent,  much  less  identical. 
Psychopathic  states  are  not  "weak  nerves"  or  "fatigued 
nerves."  Above  all,  there  is  no  need  to  obscure  the 
matter  and  resort  to  the  much  abused,  mystical  and 
mystifying  factor  of  heredity.  It  is  easy  to  shift  all 
blame  on  former  generations,  where  in  most  cases  the 
fault  is  close  at  hand,  namely,  a  debased  environment, 
a  defective  training,  and  a  vicious  education. 

Under  the  rigorous  conditions  of  primitive  life  in- 
dividuals who  have  been  unfortunate,  and  have  become 
affected  with  mental  troubles  and  emotional  afflictions 
are  mercilessly  exterminated  by  the  process  of  tribal 
and  social  selection.  Each  generation  weeds  out  the 
individuals  who  have  been  unfortunate  enough  to  fall 
under  unfavorable  circumstances,  and  have  become 
mentally  sick,  suffering  from  acquired  psychopathic 
disturbances.  In  primitive  life  the  crippled,  the 
maimed,  the  wounded,  the  sick  fall  by  the  way,  and  are 
left  to  perish  a  miserable  death.  In  fact,  the  less  for- 
tunate, the  wounded  and  the  stricken  in  the  battle  of 
life,  are  attacked  by  their  own  companions — they  are 
destroyed  by  the  ruthless  social  brute.  The  gregarious 
brute  has  no  sympathy  with  the  pains  and  sufferings 
of  the  injured  and  the  wounded.  The  faint  and  the 
ailing  are  destroyed  by  the  herd. 

Civilization,  on  the  other  hand,  tends  more  and  more 
towards  the  preservation  of  psychopathic  individuals. 
We  no  longer  kill  our  sick  and  our  weak,  nor  do  we 


it  Introduction 

abandon  them  to  a  miserable,  painful  death — we  take 
care  of  them,  and  cure  them.  Moreover,  we  prevent 
pathogenic  factors  from  exercising  a  harmful,  malign 
social  selection  of  the  "fit."  We  do  our  best  to  free 
ourselves  from  the  blind,  merciless,  purposeless  selec- 
tion, produced  by  pathogenic  micro-organisms  and  by 
other  noxious  agencies.  We  learn  to  improve  the  ex- 
ternal environment. 

We  do  not  condemn  people  to  death,  because  they  are 
infected  with  smallpox,  typhus,  typhoid  bacilli,  or  be- 
cause of  an  infected  appendix.  We  no  longer  regard 
them  as  sinful,  unclean,  accursed  and  tabooed.  We  vac- 
cinate, inoculate,  operate,  and  attempt  to  cure  them. 
By  sanitary  and  prophylactic  measures  we  attempt  to 
prevent  the  very  occurrence  of  epidemics.  Our  valua- 
tion of  individuals  is  along  lines  widely  different  from 
those  of  the  stone  age  and  the  cave  man.  We  value  a 
Pascal,  a  Galileo,  a  Newton,  a  Darwin,  a  Pasteur,  and 
a  Helmholtz  far  above  a  Milo  of  Croton  or  an  African 
Johnson. 

Civilization  is  in  need  of  refined,  delicate  and  sensi- 
tive organizations,  just  as  it  is  in  need  of  galvanometers, 
chronometers,  telephones,  wireless  apparatuses,  sensi- 
tive plates,  and  various  chemical  re-agents  of  a  highly 
delicate  character.  We  are  beginning  to  appreciate 
delicate  mechanisms^and  sensitive  organizations.  We 
shall  also  learn  to  train  and  guard  our  sensitive  natures 
until  they  are  strong  and  resistant  to  the  incident  forces 
of  an  unfavorable  environment.  The  preservation  of 
psychopathic  individuals  accounts  for  the  apparent 
increase  of  neurotics  in  civilized  communities. 

It  may  be  well  to  add  that,  although  the  occasions 
for  sudden,  intense,  overwhelming  shocks  are  not  so 
prevalent  in  organized  societies  as  they  are  in  primi- 
tive savage  communities,  the  worries,  the  anxieties,  the 


Introduction  in 

various  forms  of  slow,  grinding  fears  of  a  vague,  mar- 
ginal, subconscious  character,  present  in  commercial 
and  industrial  nations,  are  even  more  effective  in  the 
production  of  psychopathic  states  than  are  the  isolated 
occasions  of  intense  terrors  occurring  in  the  life  of  the 
primitive  man  of  the  paleolithic  or  neolithic  periods. 

In  my  works  I  lay  special  stress  on  the  fact  that  the 
psychopathic  individual  has  a  predisposition  to  dissocia- 
tive states.  Early  experiences  and  training  in  child- 
hood enter  largely  into  the  formation  of  such  a  pre- 
disposition. Still,  there  is  no  doubt  that  a  sensitive 
nervous  system  is  required, — a  brain  susceptible  to 
special  stimuli  of  the  external  environment.  This,  of 
course,  does  not  mean  that  the  individual  must  suffer 
from  stigmata  of  degeneration.  On  the  contrary,  it  is 
quite  possible,  and  in  many  patients  we  actually  find 
it  to  be  so,  that  the  psychopathic  individual  may  be 
even  of  a  superior  organization.  It  is  the  sensitivity 
and  the  delicacy  of  nervous  organization  that  make  the 
system  susceptible  to  injurious  stimulations,  to  which  a 
lower  form  of  organization  could  be  subjected  with 
impunity.  An  ordinary  clock  can  be  handled  roughly 
without  disturbance  of  its  internal  workings,  but  the 
delicate  and  complicated  mechanism  of  a  chronometer 
requires  careful  handling  and  special,  favorable  con- 
ditions for  its  normal  functioning.  Unfavorable 
conditions  are  more  apt  to  affect  a  highly  complex 
mechanism  than  a  roughly  made  instrument.  It  is 
quite  probable  that  it  is  the  superior  minds  and  more 
highly  complex  mental  and  nervous  organizations  that 
are  subject  to  psychopathic  states  or  to  states  of  dis- 
sociation. Of  course,  unstable  minds  are  also  subject 
to  dissociative  states,  but  we  must  never  forget  the 
fact  that  highly  organized  brains,  on  account  of  their 
very  complexity,  are    apt   to  become   unstable  under 


iv  Introduction 

unfavorable  conditions.  A  predisposition  to  dissocia- 
tion may  occur  either  In  degenerative  minds  or  in  minds 
superior  to  the  average.  Functional  -psychosis  requires 
a  long  history  of  dissociated,  subconscious  shocks,  given  to 
a  highly  or  lowly  organized  nervous  system,  dating  back 
to  early  childhood. 

As  Mosso  puts  It:  "The  vivid  impression  of  a  strong 
emotion  may  produce  the  same  effects  as  a  blow  on  the 
head  or  some  physical  shock."  We  may,  however,  say 
that  no  functional  psychosis,  whether  somopsychosis  or 
psychoneurosis,  can  ever  be  produced  simply  by  physi- 
cal shocks.  In  all  functional  psychoses  there  must  be  a 
mental  background,  and  it  is  the  mental  background  alone 
that  produces  the  psychosis  and  determines  the  character 
of  the  psychopathic  state. 

The  basis  of  functional  nervous  or  psychopathic  mal- 
adies Is  essentially  a  pathological  process  Involving  the 
nervous  system  in  as  definite  a  way  as  the  invasion  and 
infection  of  the  organism  by  various  species  of  bacteria, 
bacilli,  and  other  micro-organisms  which  attack  the 
individual  during  his  lifetime. 

Like  infectious  diseases,  psychopathic  deviations, 
abnormalities,  and  excesses  are  acquired  by  the  indi- 
vidual In  the  course  of  his  relations  with  the  external 
environment,  and  are  as  real  as  syphilis,  smallpox, 
diphtheria,  cholera,  and  the  bubonic  plague.  To  re- 
gard them  as  Imaginary,  or  to  relegate  them  to  the 
action  of  Providence  or  to  heredity  is  theoretically  a 
misconception,  and  practically  a  great  danger  to  human- 
ity. 

There  is  nowadays  a  veritable  craze  for  heredity  and 
eugenics.  Biology  Is  misconceived,  misinterpreted, 
and  misapplied  to  social  problems,  and  to  individual 
needs  and  ailments.  Eveiything  is  ascribed  to  heredity, 
from  folly  and  crime  to  scratches  and  sneezes.     The 


Introduction  v 

goddess  Heredity  is  invoked  at  each  flea-bite — in 
morsu  pulicis  Deum  invocare.  Even  war  is  supposed 
to  be  due  to  the  omnipotent  deity  of  Heredity.  Superior 
races  by  their  patriotism  and  loyalty  destroy  the  weak 
and  the  helpless,  and  relentlessly  exterminate  all  peace- 
ful tribes.  Such  warlike  stock  comes  of  superior  clay. 
The  dominant  races  have  some  miraculous  germ-plasm 
(chromatin)  with  wonderful  dominant  "units"  (chro- 
mosomes) which,  like  a  precious  heritage,  these  races 
transmit,  unsullied  and  untarnished,  to  their  descend- 
ants. Wars,  carnage,  butcheries  make  for  progress, 
culture,  and  evolution.  Our  boasted  civilization  with 
its  "scientific"  business  thoroughness  and  its  ideal  of 
"efficiency"  attempts  to  carry  into  effect  this  quasi- 
evolutionary  doctrine — this  apotheosis  of  brute  force 
under  the  aegis  of  science.  The  eugenic  belief  is  really 
a  recrudescence  of  the  ancient  savage  superstition  of 
the  magic  virtues  of  noble  blood  and  of  divine  kingly 
stock. 

All  nervous,  mental,  neuropathic,  and  psychopathic 
maladies  are  supposed  to  be  a  matter  of  heredity. 
If  people  are  poor,  ignorant,  superstitious,  stupid,  de- 
graded, brutal,  and  sick,  the  eugenists  unhesitatingly 
put  it  all  up  to  poor  stock.  The  eugenic  remedy  is  as 
simple  as  it  is  believed  to  be  efficacious;  Introduce  by 
legislation  "efficient"  laws  favoring  "eugenic"  mar- 
riage, sterilize  all  the  "unfit,"  and  teach  the  masses 
control  of  births.  The  select  and  chosen  stock  alone 
should  multiply — the  millennium  is  then  bound  to  come. 
Such  is  the  doctrine  of  our  medico-biological  sages. 

"Scientific"  farmers  and  breeders  of  vegetables, 
fruits,  and  cattle  are  regarded  as  competent  judges  of 
human  "breeders."  Agriculturists  and  horticulturists 
set  themselves  up  as  advisers  in  "the  business  of  raising 
good  crops  of  efficient  children. "  Bachelors,  spinsters, 
and  the  childless    generally,  are  specially  versed    in 


vi  Introduction 

eugenic  wisdom  and  pedagogics.  All  social  ills  and 
individual  complaints  are  referred  to  one  main  source — 
heredity.  With  the  introduction  of  eugenic  legislation, 
with  the  extermination  of  the  socially  unfit,  among 
whom  the  greatest  men  and  women  may  be  included, 
with  the  philanthropic  sterilization  of  the  "defectives," 
with  the  breeding  of  good  "orthodox,  common  stock," 
and  with  the  eugenic  Malthusian  control  of  births,  all 
evil  and  disease  on  earth  will  cease,  while  the  Philistine 
"superman"  will  reign  supreme  for  evermore. 

In  the  Middle  Ages  all  diseases  and  epidemics,  all 
wars,  all  social  and  private  misfortunes  were  considered 
as  visitations  of  Divine  wrath.  In  modern  times  our 
would-be  eugenic  science  refers  all  ills  of  the  flesh  and 
woes  of  the  mind  to  an  outraged  Heredity.  The  dark 
ages  had  resort  to  prayers,  fasts,  and  penitence,  while 
our  age  childishly  pins  its  faith  to  the  miraculous  virtues 
and  rejuvenating,  regenerative  powers  of  legislative, 
eugenic  measures,  sterilization,  seclusion,  restriction  of 
marriage,  and  to  the  eugenic  Malthusian  control  of 
births. 

Our  scientists  in  eugenics  gather  hosts  of  facts, 
showing  by  elaborate  statistical  figures  that  the  family 
history  of  neurotics  reveals  stigmata  of  degeneration 
in  the  various  members  of  the  family.  "The  Jukes" 
and  their  ilk  are  trumpeted  about  as  great  discoveries 
of  eugenic  research  work.  Any  group  of  individuals  of 
various  "breeds"  and  "families,"  living  under  the 
action  of  the  same  conditions,  social,  economical,  and 
educational  will  have  the  same  impress.  Anthropology 
has  found  this  out  in  the  case  of  so-called  "nations" 
and  "races."  The  eugenic  inquirers  do  not  stop  for  a 
moment  to  think  over  the  fact  that  the  same  sort  of 
evidence  can  be  easily  brought  in  the  case  of  most 
people.  In  fact,  the  eugenists  themselves,  when  in- 
quiring into  the  pedigree  of  talent  and  genius,  invari- 


Introduction  vii 

ably  find  somewhere  in  the  family  some  form  of  disease 
or  degeneration.  This  sort  of  "scientific"  evidence 
leads  some  eugenic  speculators,  without  their  noticing 
the  reductio  ad  absurdum,  to  the  curious  conclusion  or 
generalization  that  degeneration  is  present  in  the 
family  history  of  the  best  and  the  worst  representatives 
of  the  human  race. 

The  so-called  scientific  method  of  the  eugenists  is 
radically  faulty,  in  spite  of  the  rich  display  of  long 
pedigrees  and  family  histories,  of  colored  plates,  stained 
tables,  glittering  biological  speculations,  brilliant  math- 
ematical formulae,  and  complicated  statistical  calcu- 
lations. The  eugenists  pile  Ossa  on  Pelion  of  facts  by 
the  simple  method  of  enumeration  which  Bacon  and 
the  thinkers  coming  after  him  have  long  ago  con- 
demned as  puerile  and  futile.  From  the  savage's  belief 
in  sympathetic,  imitative  magic  with  its  consequent 
superstitions,  omens,  and  taboos  down  to  the  articles  of 
faith  and  dogmas  of  the  eugenists  we  find  the  same 
faulty,  primitive  thought,  guided  by  the  puerile  method 
of  simple  enumeration,  and  controlled  by  the  wisdom 
of  the  logical  post  hoc,  ergo  propter  hoc. 

What  should  we  say  of  the  medical  man  who  should 
claim  that  measles,  mumps,  cholera,  typhoid  fever, 
yellow  fever,  malaria,  tetanus,  and  various  other  in- 
fectious diseases  are  hereditary  by  quoting  learnedly 
long  tables  of  statistics  to  the  effect  that  for  several 
generations  members  of  the  same  family  suffered  from 
the  same  infectious  diseases?  What  should  we  say  of 
the  medical  advice,  forbidding  marriage  to  individuals 
whose  family  history  reveals  the  presence  of  exanthe- 
mata? We  stamp  out  epidemics  not  by  eugenic 
measures,  but  by  the  cleansing  of  infectious  filth  and 
by  the  extermination  of  pathogenic  micro-organisms. 

Every  human  being  has  a  predisposition  to  small- 
pox, cholera,  tetanus,  bubonic  plague,  typhus  fever, 


via  Introduction 

malaria,  and  to  like  infectious  diseases,  but  there  is 
no  inherent  necessity  for  everyone  to  fall  a  victim  to 
the  action  of  pathogenic  organisms,  if  the  preventive 
and  sanitary  conditions  are  good  and  proper.  No  one 
is  immune  against  the  action  of  bullets,  cannon  balls, 
shells,  and  torpedoes,  or  to  the  action  of  various  poisons, 
organic  and  inorganic,  but  one  is  not  doomed  to  be 
killed  by  them,  if  one  does  not  expose  oneself  to  their 
deadly  action.  Every  living  organism  is  by  the  very 
nature  of  its  cellular  tissues  predisposed  to  the  wound- 
ing by  sharp  instruments,  or  to  the  burning  action  of 
fire,  but  this  does  not  mean  an  inherent  organic  weak- 
ness to  which  the  organism  must  necessarily  submit 
and  perish.  We  are  all  of  us  predisposed  to  get  in- 
jured and  possibly  killed,  when  we  fall  down  from  a 
high  place,  or  when  we  are  run  over  by  an  automobile 
or  by  a  locomotive,  but  there  is  no  fatalistic  necessity 
about  such  accidents,  if  care  is  taken  that  they  should 
not  occur. 

We  may  be  predisposed  to  neurosis  by  the  very 
nature  of  complexity,  delicacy,  and  sensitivity  inherent 
in  the  structure  of  a  highly  organized  nervous  system, 
and  still  we  may  remain  healthy  and  strong  all  our  life 
long,  provided  we  know  how  to  keep  away  from  noxious 
agencies.  The  creed  of  the  inevitable  fatality  of 
neurosis  is  as  much  of  a  superstition  as  the  Oriental 
belief  in  the  fatalism  of  infectious  diseases,  plagues, 
and  accidents  of  all  kinds.  Such  fatalistic  superstitions 
are  dangerous,  fatal,  because  they  distract  the  attention 
from  the  actual  causes  and  from  the  requisite  prophy- 
lactic measures. 

We  go  far  afield  in  search  for  the  remote  source  of 
our  troubles,  when  the  cause  is  close  at  hand.  We  need 
only  open  our  eyes  to  see  the  filth  of  our  towns,  the 
foul,  loathsome  slums  of  our  cities,  the  miserable  train- 
ing, the  wretched  education  given  to  our  children,  in 


Introduction  ix 

order  to  realize  at  a  glance  the  source  of  our  ills  and 
ailments.  We  should  lay  the  guilt  at  the  door  of  our 
social  order.  fVe  starve  our  young.  We  starve  our 
children  physically  and  mentally. 

We  piously  sacrifice  our  tender  children  and  the 
flower  of  our  youth  to  the  greedy,  industrial  Moloch 
of  a  military,  despotic,  rapacious  plutocracy.  Wit- 
ness semi-civilized  Europe  with  its  lauded  culture 
brutally  shedding  the  blood  of  its  youth  and  manhood 
on  the  altar  of  commercial  patriotism.  It  is  not  heredi- 
ty, it  is  the  vicious  conditions  of  life  that  stunt  the  physical, 
nervous,  and  mental  growth  of  our  young  generation. 
When  we  are  confronted  with  the  miserable,  degraded, 
crippled  forms  of  our  life,  we  fall  back  cheerfully  on 
some  remote  grandparent  and  credulously  take  refuge 
in  the  magic  panacea  of  eugenics. 

The  practical  aspect  is  clear.  Psychopathic  neurosis 
in  its  two  varieties,  Somatopsychosis  (Somopsychosis) 
and  Psychoneurosis,  is  not  hereditary,  but  acquired. 
We  should  not  shift  the  blame  on  former  generations 
and  have  resort  to  eugenics,  we  must  look  to  the  im- 
provement of  mental  hygienic  conditions  of  early  child- 
hood, and  to  the  proper  education  of  the  individual. 

It  is  easy  to  put  the  blame  on  grandparents, — they 
are  dead  and  cannot  defend  themselves.  Could  they 
arise  from  their  graves,  they  could  tell  some  bitter 
truths  to  their  'degenerate'  descendants  who  are  ready 
to  shift  responsibility  to  other  people's  shoulders.  It 
is  about  time  to  face  the  truth  fairly  and  squarely,  a 
truth  which  is  brought  out  by  recent  investigations  in 
psychopathology,  that  the  formation  of  psychopathic 
neurosis  with  all  its  characteristic  protean  symptoms,  is 
not  hereditary,  hut  acquired.  Neurosis  arises  within  the 
life  cycle  of  the  individual, — it  is  due  to  faulty  training 
and  harmful  experience  of  early  child  life. 


X  Introduction 

Future  medicine  will  be  largely  prophylactic,  pre- 
ventive, sanitary,  hygienic,  dietetic.  What  holds  true 
of  medicine  in  general  holds  true  of  that  particular 
branch  of  it  that  deals  with  neurosis.  The  treatment 
will  become  largely  prophylactic,  preventive,  educa- 
tional, or  pedagogic.  It  is  time  that  the  medical  and 
teaching  professions  should  realize  that  functional  neurosis 
is  not  congenital^  not  inborn,  not  hereditary,  but  is  essen- 
tially the  result  of  a  defective  education  in  early  child  life. 

Boris  Sidis. 
Sidis  Institute, 

Portsmouth,  New  Hampshire,  1915. 


TABLE  OF  CONTENTS 

CHAPTER  PAGE 

Introduction i 

I.     Psychopathic  Reflexes 21 

II.     Main  CHnical  Forms  of  Neuroses  and 

Psychopathies 26 

III.  The  Source  of  Psychopathies 33 

IV.  Embryonic    Personality    and    Psycho- 

pathic Afl^ections 38 

V.     The    Fear    Instinct    and    Psychopathic 

States 43 

VI.     Manifestations    of    Fear    Instinct    and 

Symptoms  of  Psychopathic  Diseases. .  54 
VII.     The  Main   Principles  of  Psychopathic 

Diseases 64 

VIII.     The  Law  of  Recession 73 

IX.     The  Law  of  Reversion 76 

X.     The  Process  of  Degeneration 81 

XL     The    Impulse    of    Self-Preservation    in 

Psychopathic  Diseases 86 

XII.     Neuron  Energy  and  Neurosis 129 

XIII.  Clinical  Cases 163 

XIV.  Psychognosis  of  Psychopathic  Cases ..  .  185 
XV.     Psychognosis  of  the  Psychopathic  Sub- 
stratum   247 

XVI.     Psychopathic  Fears 280 

XVII.     General  Psychotherapeutic  Methods.  .  .  332 

XVIII.     The  Method  of  Hypnoidization 363 

XIX.     Clinical  Cases  of  Hypnoidal  Treatment . .  376 
XX.     The  Hypnoidal  State  and  Reserve  En- 
ergy    396 

Index 409 


The  Causation  and  Treatment 
of  Psychopathic  Diseases 

CHAPTER  I 

PSYCHOPATHIC   REFLEXES 

THE  profound  influence  of  the  central  nervous 
system,  more  especially  of  the  cortex  with  its 
mental  processes,  on  bodily  activities,  on 
glandular,  circulatory,  and  visceral  functions, 
is  now  firmly  established  by  psychophysiological  and 
psychopathological  research  work.  As  Darwin  puts 
it:  "The  manner  in  which  the  secretions  of  the  alimen- 
tary canal  and  of  certain  glands,  as  the  liver,  kidneys, 
or  mammae  are  affected  by  strong  emotions,  is  an 
excellent  instance  of  the  direct  action  of  the  sensorium 
on  these  organs."  The  heart  is  extremely  sensitive 
to  sensory  and  ideosensory  stimulations.  Claude 
Bernard  has  shown  how  the  least  excitement  of  sensory 
nerves  reacts  through  the  pneumogastric  nerve  on  the 
heart.  The  vasomotor  system  is  directly  acted  on  by 
the  sensorium. 

Early  investigators  (Bidder,  Schmidt,  Richet)  ob- 
served the  fact  that  the  sight  of  food  causes  the  secre- 
tion of  gastric  juice.  PavlofF  in  his  experiments  has 
shown  that  the  central  nervous  system  acts  on  the 
secretions  of  the  stomach  through  the  vagi  nerves  that 
innervate  its  glandular  activity.  PavlofF  made  a 
gastric  fistula  in  the  dog,  then  exposed  the  esophagus, 
opened  it,  and  sewed  the  cut  end  to  the  edges  of  the 
wound.  Food  taken  by  the  mouth  fell  out  through 
the  opening,  but  an  abundant  secretion  of  gastric  juice 

21 


22      Causation  and  Treatment^  Psychopathic  Diseases 

was  observed.  There  are  two  moments  in  the  process 
of  secretion:  (i)  The  psychic  moment,  the  perception 
of  food  and,  (2)  the  chemical  moment.  According  to 
Pavloff,  the  psychic  moment  is  the  more  important. 

By  the  term  "unconditional  reflex"  PavlofF  means 
to  indicate  the  response  which  the  animal  with  a  fistula 
in  the  secretory  glands  reacts  by  secretion  to  a  normal 
stimulus,  such  as  bread,  meat,  and  other  food.  By 
"conditional  reflex"  PavloflF  indicates  the  reaction 
made  by  the  operated  animal  to  a  stimulus  artificially 
associated  with  the  unconditional  reflex.  Thus  during 
the  time  the  animal  is  fed,  a  light  is  flashed  or  a  whistle 
is  sounded  or  various  figures  are  shown  to  the  animal,  as 
Doctor  Orbeli  has  done.  After  a  series  of  repetition, 
twenty,  thirty,  or  a  hundred,  the  animal  reacts  with 
secretion  to  that  artificially  associated  stimulus.  When 
another  stimulus  is  in  its  turn  associated  with  that  of 
the  conditional  reflex,  the  result  is  not  an  increase,  but 
a  total  inhibition  of  the  conditional  reflex. 

Savadsky  modified  the  conclusions  of  the  previous 
investigators,  but  he  affirms  the  fact  that  an  intense 
stimulus  completely  annihilates  the  secretion  of  the 
conditional  reflex,  such  as  is  due  to  scratch  stimulus, 
for  instance,  while  a  weak  stimulus  produces  a  lesser 
effect.  He  finds  that  the  external  stimulus  inhibits 
the  condition  of  the  nerve  centres.  In  summarizing 
the  work  of  previous  investigators  in  Pavloff's  labora- 
tory, Orbeli  says:  "Vasiliev  and  Mishtovt  have  shown 
that  any  phenomenon  indifferent  in  itself  may  not 
only  become  a  source  of  a  new  conditional  reflex,  but 
may  become  a  special  inhibitory  agent  in  relation  to 
the  existing  conditional  reflexes.  This  quality  of  the 
nervous  system  to  work  out  special  cases  of  inhibition 
makes  the  conditional  reflexes  a  delicate  index  of 
reactions  of  the  organism  to  its  external  environment. " 

On  the  strength  of  experiments  performed  on  the 


Psychopathic  Reflexes  23 

visual  reactions  of  the  dog,  Orbeli  comes  to  the  same 
conclusion  with  Vasiliev,  Mishtovt,  Babkin,  and  Sav- 
adsky. 

Similarly  in  the  experiments  carried  on  in  my  lab- 
oratory on  the  galvanic  reflex,  I  find  that  the  results 
coincide  with  Pavloff's  experiments  on  inhibition. 
In  a  letter  to  me  Pavloff  writes  that  he  is  at  work  on 
the  higher  activities  of  the  brain  of  the  dog,  studying 
mental  reactions  by  the  methods  of  conditional  reflexes. 
According  to  Pavloff,  mental  life,  however  complex, 
can  be  studied  successfully  by  the  reactions  of  glandular 
secretions. 

An  intimate  relation  exists  between  the  functions 
of  the  central  nervous  system  on  the  one  hand  and 
the  sensory,  motor,  glandular,  and  visceral  functions 
on  the  other.  This  vital  relation,  though  unobtrusive 
to  the  casual  observer,  stands  out  clear  and  distinct 
in  the  domain  of  certain  nervous  and  mental  disturb- 
ances, such  as  hysteria,  hystero-epilepsy,  larval  epilep- 
sy, neurasthenia,  psychasthenia.  All  such  conditions 
are  mental  disturbances,  conscious  or  subconscious, 
and  are  termed  by  me  psychopathies,OT  recurrent  mental 
states.  Recurrence  of  the  symptom  complex  is  path- 
ognomonic of  psychopathies,  or  briefly,  of  neurosis. 
This  essential  trait  of  recurrence,  found  in  neurosis,  is 
a  reversion  to  a  low  type  of  mental  life.  I  refer  all 
those  who  are  interested  in  the  subject  to  my  work  on 
the  moment  consciousness,  studied  from  a  psychobio- 
logical  standpoint  in  my  recent  volume,  The  Founda- 
tions of  Normal  and  Abnormal  Psychology. 

In  psychopathic  affections  the  disturbance  consists 
in  the  formation  of  non-adaptive  associations  of  central 
neuron-systems  with  receptors  which  normally  do  not 
have  as  their  terminal  response  the  particular  motor 
and  glandular  reactions. 


24       Causation  and   Treatment^  Psychopathic  Diseases 

In  Pavloff's  experiments  the  flow  of  saliva  or  of 
gastric  juice  in  the  dog  with  the  fistula  could  be  brought 
about  by  association  with  blue  light,  with  the  sound  of 
a  whistle,  by  a  tickle,  a  scratch,  or  by  various  diagrams, 
squares,  circles,  as  in  the  experiments  of  Orbeli.  What 
holds  true  in  the  case  of  conditional  reflexes  in  regard 
to  saliva  and  gastric  juice,  also  holds  true  of  other 
conditional  reflexes  formed  by  psychopathies.  The 
mechanism  in  psychopathies  is  the  same  which  PavlofF 
and  bis  disciples  employ  in  the  formation  of  various 
conditional  reflexes  in  the  case  of  the  dogs.  All  kinds 
of  abnormal  reactions  of  a  morbid  character  may  thus 
be  formed  in  response  to  ordinary  stimuli  of  life. 

Emotions  are  specially  subject  to  associations  of 
a  morbid  or  psychopathological  character.  The  physi- 
ological effects  of  emotions  may  be  linked  by  associa- 
tive processes  with  ideas,  percepts,  and  sensations  which 
are  ordinarily  either  indifferent  or  give  rise  to  reactions 
and  physiological  effects  of  a  type  opposite  to  that  of 
the  normal.  Milk  may  excite  nausea,  a  rose  induce 
disgust,  red  paint  produce  fainting,  while  the  croak  of 
a  crow,  Limburger  cheese,  overripened  game,  the  smell 
of  garlic  and  asafoetida  may  be  enjoyed  with  delight. 

The  reactions  of  muscle  and  gland  are  like  so  many 
electric  bells  which  by  various  connections  and  com- 
binations may  be  made  to  ring  from  any  sensory  button 
or  receptor,  as  Sherrington  would  put  it.  An  object, 
however  harmless,  may  become  associated  with  re- 
actions of  anguish  and  distress.  This  holds  true,  not 
only  of  man,  but  also  of  the  life  of  the  lower  animals. 

Associations  and  reactions,  motor,  circulatory,  gland- 
ular, however  abnormal,  formed  by  young  animals, 
persist  through  life.  This  holds  specially  true  in  the 
case  of  the  higher  and  more  sensitive  animal  organisms, 
such  as  the  mammals.  All  training  and  formation 
of  peculiar  reactions,  such  as  various  tricks,  habits, 


Psychopathic  Reflexes  25 

scare-habits,  scare-pain  reflexes  depend  entirely  on  this 
plasticity  of  the  nervous  system  to  form  new  associa- 
tions, or  as  PavlofF  and  his  school  put  it,  to  form  condi- 
tional reflexes  and  inhibitions  in  regard  to  glandular 
secretions  as  well  as  to  other  psychophysiological 
reactions. 

Psychopathies  are  essentially  pathological  affections 
of  associative  life.  Psychopathic  maladies  are  the 
formation  of  abnormal,  morbid  "conditional  reflexes" 
and  of  inhibitions  of  reactions  of  associative  normal 
life  activity. 


CHAPTER  II 

MAIN     CLINICAL     FORMS     OF     NEUROSES     AND      PSYCHO- 
PATHIES 

A  brief  outline  of  the  classification  of  nervous 
and  mental  diseases,  made  by  me  in  my 
various  works,  is  of  importance  to  a  clear 
understanding  of  the  etiology  and  differen- 
tial diagnosis  of  the  neurotic  affections  under  discussion. 

The  different  forms  of  nervous  and  mental  diseases 
may  be  classified  into  organic  Sind  functional. 

By  organic  affections  we  mean  to  indicate  all  patho- 
logical modifications  of  the  neuron  and  its  processes 
taking  place  in  the  very  structure,  probably  in  the 
cytoreticulum,  of  the  nerve  cell.  Under  this  category 
come  such  maladies  as  general  paralysis,  dementia 
praecox,  and  mental  and  nervous  affections  of  an  in- 
volutionary  and  degenerative  nature.  Such  diseases 
are  termed  by  me  Organopathies  or  Necropathies. 

By  functional  affections  we  mean  to  indicate  all 
neuron  changes  in  which  the  neuron  functions  and 
their  reactions  to  external  and  internal  stimulations 
are  involved  in  the  pathological  process  without,  how- 
ever, affecting  the  anatomical  structure  of  the  nerve 
cell.  The  pathological  changes  are  not  permanent, 
recovery  of  normal  function  is  possible. 

Functional  nervous  and  mental  diseases  may  in 
their  turn  be  subdivided  into  Neuropathies  and  Psycho- 
pathies. 

Functional  neuropathic  diseases  are  disturbances  of 
functioning  activity  of  the  neuron,  due  to  defective 
metabolism  in  cellular  nutrition,  brought  about  by 
external,  and  especially  by  internal  stimuli-secretions, 

26 


Chnical  Forms  of  Neuroses  and  Psychopathies         Tj 

hormones,  and  other  agencies.  The  pathological  pro- 
cess in  functional  nervous  and  mental  diseases  produces 
few,  if  any,  anatomical,  structural  changes  in  the 
neuron.  The  pathology  of  functional  neuropathic  diseases 
(probably  of  the  cytoplasm)  is  essentially  chemico-physi- 
ological  in  character. 

Neuropathic  diseases  include  maladies  in  which  the 
neuron  undergoes  degenerative  changes  which  at  first 
may  bring  about  an  apparent  increase,  then  an  inhibi- 
tion, and  finally  a  complete  suspension  of  neuron 
function,  not  terminating  in  the  destruction  of  the 
neuron. 

This  follows  the  general  physiological  law  that  all 
causes  which  tend  to  destroy  the  vital  functions  of  cell 
activity  begin  at  first  to  work  as  stimulants  and  after- 
wards become  depressants,  finally  ending  in  the  total 
destruction  of  the  cell  or  of  the  neuron  in  the  case  of 
the  nervous  system.  Thus  in  many  cases  small  doses 
of  opium  or  of  morphine,  chloral  or  other  toxic  and 
autotoxic  products  bring  about  an  excitement.  In 
such  cases  we  should  increase  the  dose  or  repeat  it,  if 
we  wish  to  obtain  depressant  effects.  In  ether  and 
chloroform  anesthesia  before  the  deep  state  of  anes- 
thesia sets  in  there  is  a  stage  of  excitement.  This  law 
holds  true  in  the  case  of  the  process  of  degeneration  of 
the  nervous  system  in  the  various  forms  of  nervous 
and  mental  diseases  as  in  the  process  of  the  downward 
course  of  cellular  disintegration. 

In  neuropathic  disturbances  neuron  restitution  is 
possible.  Neuropathic  affections  are  produced  by 
poisons,  organic  or  inorganic,  by  autotoxic  products, 
by  hyposecretion  or  hypersecretion,  or  total  absence  of 
glandular  secretion  or  hormones  in  the  economy  of  the 
organism.  Here  belong  all  the  temporary,  or  recurrent 
maniacal,  melancholic,  and  delusional  states,  puerperal 
mania,   epileptic  insanity,  the  mental   aberrations  of 


28      Causation  and  Treatment,  Psychopathic  Diseases 

adolescent  and  climacteric  periods,  periodic  insanity, 
alternating  insanities,  and  in  general  all  the  mental 
affections  at  present  known  under  the  description  of 
manic-depressive  insanity. 

Where  the  disease  depends  not  so  much  on  the  neuron 
itself,  but  on  the  interrelation  of  neurons  in  a  complex 
system,  on  association  of  systems  of  neurons,  the  con- 
dition is  psychopathic  in  nature.  In  psychopathic 
troubles  the  neuron  itself  may  remain  unaffected,  may 
be  perfectly  normal  and  healthy.  The  disorder  is  due 
to  associations  with  systems  of  neurons  which  are 
usually  not  called  into  action  by  the  function  of  that 
particular  neuron  or  neuron  system. 

Briefly  stated: 

Organopathies  or  Necropathies  include  a  group  of 
psychophysiological  symptoms  accompanied  by  struc- 
tural, necrotic  changes  of  the  neuron,  terminating  in 
the  ultimate  death  of  the  neuron  systems  involved  in 
the  pathological  process. 

Neuropathies  include  a  group  of  psychophysiologi- 
cal manifestations  due  to  pathological  functional  neu- 
ron modifications,  capable  of  restitution  through  a 
more  perfect,  more  normal  metabolism. 

Psychopathies  are  pathological  phenomena  of  psy- 
cho-physiological dissociation  and  disaggregation  of 
neuron  systems  and  the  resultant  disturbances  of  ag- 
gregate functions,  the  neuron  itself,  remaining  undam- 
aged and  untouched. 

The  Psychopathies  may  be  classified  into:  Somato- 
psychoses or  Somopsychoses  and  Psychoneuroses. 

This  classification  may  be  represented  by  the  follow- 
ing diagram  (Fig.  i): 

The  psychopathies  may  present  chiefly  somatic 
symptoms,  such  as  paralysis,  contractures,  convulsions, 
or  anesthesia,  hypoesthesia,  hyperaesthesia  of  the  vari- 
ous organs,  glands,  and  tissues.  Such  mental  diseases 


Clinical  Forms  of  Neuroses  and  Psychopathies     29 


Nervous  and  Mental  Diseaiass 


Organic 


Organopathles 

Neuropathies 


Somatopsyoheses 

or 
Somo  psychoses 


Functional 


Psychoneurosea 
.    or  , 
Neuropsyohoaes 


Fig.  I 


may  be  termed  somatic  psychoses,  somatopsychoses. 
The  somatic  psychoses  or  neuroses  would  comprise  the 
various  manifestations  of  what  is  at  present  described 
as  hysteria  and  neurasthenia  as  well  as  the  milder 
forms  of  hypochondriasis.  In  all  such  diseases  the 
psychical  symptoms  form  the  prominent  elements  of  the 
mental  malady.  The  patient  remains  unaware  of  the 
underlying  mental  grounds.  So  much  is  this  the  case 
that  the  patient  is  offended,  if  his  trouble  is  regarded  as 
purely  mental  in  character.  The  mental  side  of  the 
diseases  is  then  said  to  be  submerged  subconsciously. 
In  the  psychoneuroses  or  neuropsychoses  the  physical 
symptoms  are,  on  the  contrary,  few  or  none  at  all, 
while  the  predominating  symptoms  are  entirely  of  a 
mental  character.  The  patient  ignores  his  physical 
condition,  even  if  any  exists,  .and  his  whole  mind  is 
occupied  with  mental  troubles.  Such  conditions  are 
to  be  found  in  all  obsessions,  fixed  ideas,  imperative 
impulses,  and  other  allied  morbid  mental  states.     Thus 


30       Causation  and   Treatment,  Psychopathic  Diseases 

one  patient  is  in  agony  over  the  unrighteousness  of  his 
conduct,  another  is  obsessed  by  a  terror  of  some  myste- 
rious agency,  or  by  religious  and  moral  scruples. 

The  two  clinical  forms  of  psychopathies  are  in  strong 
contrast.  In  the  somatic  psychopathies  or  somatopsy- 
choses, the  patient  brings  before  the  physician  physi- 
cal symptoms — stomach  derangements,  intestinal  pains, 
contractures  of  limbs,  menstrual  disturbances,  affec- 
tions of  the  sexual  organs  and  their  functions,  paresis, 
paralysis,  anesthesia,  headaches,  and  similar  bodily 
troubles.  It  is  for  the  physician  to  discover  the  under- 
lying mental  states.  In  the  mental  forms,,  the  psycho- 
neuroses,  the  patient  omits  reference  to  his  physical 
condition.  He  usually  states  that  he  has  always  been 
physically  well,  and  some  patients  assert  that  they  are 
sure  that  they  will  always  be  physically  well,  that  the 
whole  trouble  is  purely  mental.  "I  have  no  physical 
trouble,"  he  tells  the  physician,  "all  my  troubles  are 
mental.  If  you  could  cure  me  of  my  mental  suffering, 
I  should  be  perfectly  happy." 

The  psychosomatic  patient  lays  stress  on  his  physical 
symptoms  and  is  offended  when  they  are  declared  to  be 
mental;  the  psychoneurotic,  on  the  contrary,  insists 
on  his  mental  symptoms,  and  becomes  impatient  when 
the  physician  pays  attention  to  physical  symptoms  or 
to  bodily  functions.  The  psychosomatic  patient  be- 
lieves he  is  afflicted  with  some  awful.  Incurable,  physical 
malady,  such  as  cardiac  trouble,  tuberculosis,  or  some 
other  fatal  bodily,  disease.  The  psychoneurotic,  on 
the  contrary,  ignores  all  physical  troubles,  but  he  thinks 
he  is  on  the  verge  of  insanity.  The  psychosomatic 
seeks  to  be  assured  that  he  is  not  an  incurable  invalid. 
The  psychoneurotic  wants  to  be  certain  that  he  is  not 
crazy.  The  psychosomatic  wishes  to  know  whether  or 
no  he  is  really  and  truly  free  from  some  malignant 
disease,    some  horrible  infection,  or  some  fatal  physical 


Clinical  Forms  of  Neuroses  and  Psychopathies     31 

malady.  The  psychoneurotic  Is  anxious  to  be  con- 
vinced that  he  Is  not  Insane,  and  that  he  Is  not  to  end 
the  rest  of  the  days  of  his  life  In  some  retreat  or  asylum 
for  the  Insane.  The  clinical  difference  between  the  soma- 
topsychoses and  neuropsychoses  is  a  fundamental  one, 
and  is  of  the  utmost  consequence  in  prognosis  and  treat- 
ment. 

The  somatopsychoses  simulate  physical  and  organic 
nervous  troubles.  Thus,  many  "hysterical"  forms 
simulate  tabes,  or  paralysis  agltans,  hemiplegia,  para- 
plegia, or  epilepsy,  while  many  of  the  neurasthenic, 
hypochondriacal,  and  their  allied  states  simulate  tumor 
or  cancer  of  the  stomach,  intestinal  obstructions  and 
glandular  derangements;  cardiac,  laryngeal,  pneumonic, 
hepatic,  splanchnic,  ovarian,  tubal,  uterine,  renal,  and 
hundreds  of  other  bodily  afflictions. 

The  neuropsychoses  or  psychoneuroses  simulate  all 
forms  of  mental  disease,  beginning  with  melancholia 
and  mania  and  ending  with  general  paresis  and  de- 
mentia. 

Psychopathic  affections  can  be  differentiated  from 
the  various  forms  of  Insanity  by  the  following  Important 
symptom:  Readiness  of  the  patient  to  get  an  insight 
Into  his  trouble.  The  psychosomatic  and  the  psycho- 
neurotic are  characterized  by  the  fact  that  they  are 
anxious  to  learn  the  nature  and  causation  of  their 
trouble.  They  are  eager  to  learn  the  psychogenesis 
of  their  affection,  and  will  do  everything  in  their  power 
to  help  the  physician  In  his  examination  and  study  of 
their  case.  Even  In  the  cases  where  the  Idea  is  fixed, 
the  obsession  intense,  and  the  Impulse  uncontrollable, 
they  are  anxious  to  listen  to  views  different  from  their 
own,  and,  in  fact,  are  always  on  the  lookout  for  some 
help  to  get  rid  of  the  insistent  mental  states. 

No  matter  how  fixed  the  mental  state  may  be.  It  will 
temporarily  give  way  to  suggestion   and   persuasion. 


32      Causation  and  Treatment,  Psychopathic  Diseases 

No  matter  how  deep  and  intense  the  emotional  state 
of  the  psychoneurotic  and  psychosomatic,  it  can  be 
distracted  and  dissipated  by  the  personal  touch  of  some 
firm  and  trusted  friend,  or  by  the  influence  of  the  con- 
fidential physician  who  has  an  insight  into  the  nature 
of  the  malady.  Neither  the  emotions  nor  the  ideas  are 
immovably  fixed, — they  are  always  ready  to  give  way  to 
other  associations.  Moreover,  the  psychoneurotic  is 
always  ready  to  receive  such  different  associations  and 
welcomes  them  with  all  his  might  and  main.  There  is 
a  great  amount  of  optimism  in  the  psychosomatic  and 
psychoneurotic.  This  is  clearly  revealed  in  the  various 
religious  and  mental  cults  which  often  delight  the  heart 
of  the  psychopathic  patient.  There  is  a  large  amount 
of  cheerful  hope  in  the  very  make-up  of  functional 
psychosis. 


CHAPTER  III 

THE    SOURCE    OF    PSYCHOPATHIES 

THE  main  source  of  psychopathic  diseases  is  the 
fundamental  instinct  of  fear^  with  its  manifesta- 
tions, the  feeling  of  anxiety,  anguish,  and  worry. 
Fear  Is  one  of  the  most  primitive  instincts 
of  animal  life.  Our  life  is  so  well  guarded  by  the  pro- 
tective agencies  of  civilization  that  we  hardly  realize 
the  extent,  depth,  and  overwhelming  effect  of  the  fear 
instinct.  Fear  is  rooted  deep  down  in  the  Ye^vy  organi- 
zation of  animal  existence;  it  takes  its  root  in  the  very 
essence  of  life, — the  instinct  of  self-preservation.  Pri- 
mus in  orhe  deos  fecit  timor. 

"The  progress  from  brute  to  man,"  says  James, 
"is  characterized  by  nothing  so  much  as  the  decrease 
in  frequency  of  the  proper  occasion  for  fear.  In  civil- 
ized life  in  particular  it  has  at  last  become  possible  for 
large  numbers  of  people  to  pass  from  the  cradle  to  the 
grave  without  ever  having  had  a  pang  of  genuine  fear. 
Many  of  us  need  an  attack  of  mental  disease  to  teach 
us  the  meaning  of  the  word.  Hence  the  possibility  of 
so  much  blindly  optimistic  philosophy  and  religion. 
Fear  is  a  genuine  instinct,  and  one  of  the  earliest  shown 
by  the  human  child." 

lUnder  "fear  instinct"  are  included  all  afferent  and  efferent  processes, 
sensory,  glandular,  and  motor  reactions  that  accompany  this  fundamental  in- 
stinct. The  sensory,  glandular,  and  motor  processes,  the  latter  processes  in 
the  form  of  afferent  kinaesthetic  sensations,  all  enter  in  a  synthetized  state 
of  what  is  re  warded  as  the  affective,  emotional  experience  of  fear.  The  sen- 
sory, glandular,  and  motor  elements,  the  afferent  and  efferent  processes,  are 
not  separate  and  distinct  from  central  elements,  as  some  psychologists  and 
psychopathologists  are  apt  to  suppose,  but  these  peripheral  processes  are 
intimately  related  to  and  even  enter  into  the  very  constitution  of  the  so 
called  central  elements  or  central  affective  processes  of  the  instinct. 

33 


34       Causation  and  Treatment,   Psychopathic  Diseases 

Slmllarlf,  Sully  says:  "Fear  appears  early  in  the 
life  of  the  child  as  it  seems  to  appear  low  down  in  the 
zoological  scale.  Fear  probably  appears  in  the  vague 
form  {i.e.,  without  any  distinct  representation  of  a 
particular  kind  of  evil)  in  connection  with  presentation, 
e.g.,  of  strange  animals,  which  have  contracted  no 
associations  from  individual  experiences  and  which 
derive  their  emotive  force  from  special  inherited 
associations.  Experience  is,  however,  the  chief  de- 
termining factor  in  the  evocation  of  fear."  "Fear," 
says  Darwin,  "  is  the  most  depressing  of  all  the  emotions ; 
and  it  soon  induces  utter,  helpless  prostration,  as  if 
in  consequence  of  or  in  association  with  the  most 
violent  and  prolonged  attempts  to  escape  from  the 
danger,  though  no  such  attempts  have  actually  been 
made." 

The  fear  of  coming  evil,  especially  if  it  is  unknown 
and  mysterious,  gives  rise  to  the  feeling  of  anxiety. 
"If  we  expect  to  suffer,"  says  Darwin,  "we  are  anx- 
ious." James  regards  anxiety,  especially  the  pre- 
cordial anxiety,  as  morbid  fear.  "The  anxious  con- 
dition of  mind, "  says  Bain,  "  is  a  sort  of  diffused  terror. " 
Fear  often  expresses  itself  through  cardiac  and  circula- 
tory affections,  giving  rise  to  the  feeling  of  anxiety. 
Anxiety  is  nothing  else  hut  the  working  oj  the  instinct  of 
fear. 

James  makes  an  attempt  to  enumerate  the  various 
objects  of  fear  in  men,  and  especially  in  children. 
Among  these  he  regards  "strange  animals,  strange 
men,  strange  places,  such  as  the  fear  of  the  sea  in  chil- 
dren who  have  not  seen  the  sea  before.  The  great 
source  of  terror  to  infancy  is  solitude.  Black  things, 
and  especially  dark  places,  holes,  caverns,  etc.,  arouse 
a  peculiarly  gruesome  fear.  This  fear,  as  well  as  that 
of  solitude,  of  being  'lost,'  are  explained  after  a  fashion 
by  ancestral  experience.     High  places  cause  a  fear  of 


The    Source   of  Psychopathies  35 

a  peculiarly  sickening  sort.  Fear  of  the  supernatural 
is  one  variety  of  fear.  This  horror  is  probably  explica- 
ble as  the  result  of  a  combination  of  simple  horrors. 
To  bring  the  ghostly  terror  to  its  maximum  many  usual 
elements  of  the  dreadful  must  combine,  such  as  loneli- 
ness, darkness,  moving  figures,  inexplicable  sounds, 
especially  of  a  dismal  character,  moving  figures  half 
discerned,  or  if  discerned,  of  dreadful  aspect,  and  a 
vertiginous  bafHing  of  expectation.  This  last  element, 
which  is  intellectual,  is  very  important.  It  produces  a 
strange  emotional  curdle  in  our  blood  to  see  a  process 
with  which  we  are  familiar  deliberately  taking  an  un- 
wonted course.  Any  one's  heart  would  stop  beating, 
if  he  perceived  his  chair  sliding  unassisted  across  the 
floor.  The  lower  animals  appear  to  be  sensitive  to 
the  mysteriously  exceptional,  as  well  as  ourselves.  My 
friend,  W.  K.  Brooks,  of  the  Johns  Hopkins  University, 
told  me  of  his  large  and  noble  dog  being  frightened  into 
a  sort  of  epileptic  fit  by  a  thread  which  the  dog  did  not 
see.  Darwin  and  Romanes  have  given  similar  experi- 
ences. The  idea  of  the  supernatural  involves  that  the 
usual  should  be  set  at  naught.  In  the  witch  and  hob- 
goblin, other  supernatural  elements,  still  of  fear,  are 
brought  in — caverns,  slime  and  ooze,  vermin,  corpses, 
and  the  like.  A  human  corpse  seems  normally  to 
produce  an  instinctive  dread  which  is  no  doubt  some- 
what due  to  its  mysteriousness,  and  which  familiarity 
rapidly  dispels." 

The  fear  of  the  unknown,  of  the  unfamiliar,  of  the 
mysterious  is  quite  common  with  children,  with  savages, 
and  barbaric  tribes.  The  fear  of  coming  unknown, 
unfamiliar  evil  is  specially  a  source  of  anxiety  to  the 
young  or  untrained,  uncultivated  minds. 

All  taboos  of  primitive  societies,  of  savages,  of  bar- 
barians, and  also  of  civilized  people  take  their  origin, 
according  to  recent  anthropological  researches,  in  the 


36     Causation  and  Treatment ^  Psychopathic  Diseases 

"perils  of  the  soul,"  or  in  the  fear  of  impending  evil. 
As  the  great  anthropologist  Frazer  puts  it:  "Men 
are  undoubtedly  more  influenced  by  what  they  fear 
than  by  what  they  love." 

We  know  how  in  the  case  of  the  ancient  nations 
omens,  whether  religious  or  meteorological,  such  as 
storms,  thunders,  lightnings,  comets,  and  eclipses,  were 
regarded  with  great  terror.  Armies  used  to  throw 
away  their  arms  and  run  panic-stricken  on  the  occasion 
of  the  appearance  of  a  comet  or  of  an  eclipse.  Even 
in  the  civilized  times  of  the  Athenian  republic  there  was 
a  terror  of  eclipses  and  of  other  unfamiliar  natural 
phenomena.  Thucydides,  in  his  history  of  the  Pel- 
oponnesian  wars,  puts  the  appearance  of  comets  among 
national  disasters.  The  fear  of  coming  unknown, 
unfamiliar  evil  is  especially  a  source  of  anxiety  to  the 
young  or  untrained,  uncultivated  minds.  This  fear 
of  some  unknown  evil  befalling  a  person  may  become 
a  source  of  great  fear  and  anxiety  when  developed  in 
early  childhood.  This  fear  of  strangeness,  of  un- 
familiarity,  a  feeling  of  being  lost,  developed  in  early 
childhood,  may  remain  unassociated  and  thus  give 
rise  to  a  state  of  vague  fear.  Different  forms  of  epilepsy 
are  often  associated  with  the  fear  instinct. 

In  most  men  the  instinct  of  fear  is  controlled,  regulat- 
ed, and  inhibited  from  very  childhood  by  education 
and  by  the  whole  organization  of  civilized,  social  life. 
There  are  cases,  however,  when  the  instinct  of  fear  is 
not  moderated  by  education  and  civilization,  when 
the  instinct  of  fear  is  aroused  by  some  particular 
incidents  or  by  particular  objects  and  states.  In  such 
cases,  fear  becomes  associated  with  definite  situations, 
giving  rise  to  morbid  fear  and  anxiety,  resulting  in  the 
mental  diseases  known  as  psychopathies  or  recurrent 
mental  states,  psychoneuroses    and    somatopsychoses. 

In  all  such  cases  we  can  find  the  cultivation  of  the 


The  Source  of  Psychopathies  37 

instinct  of  fear  in  early  childhood.  Superstitions,  and 
especially  the  early  cultivation  of  religion,  with  its 
"fear  of  the  Lord"  and  of  unknown  mysterious  agencies, 
are  especially  potent  in  the  development  of  the  instinct 
of  fear.  Even  the  early  cultivation  of  morality  and 
conscientiousness,  with  their  fears  of  right  and  wrong, 
often  causes  psychoneurotic  states  in  later  life.  Relig- 
ious, social,  and  moral  taboos  and  superstitions,  associ- 
ated with  apprehension  of  threatening  impending  evil, 
based  on  the  fear  instinct,  form  the  germs  of  psycho- 
pathic affections. 

What  we  find  on  examination  of  the  psychogenesis 
of  psychopathic  cases  is  the  presence  of  the  fear  instinct 
which  becomes  associated  with  some  interest  of  life. 
The  interest  may  be  physical  in  regard  to  bodily  func- 
tions, or  the  interest  may  be  sexual,  social;  it  may  be 
one  of  ambition  in  life,  or  it  may  be  of  a  general  charac- 
ter, referring  to  the  loss  of  personality,  or  even  to  the 
loss  of  mind.  The  fear  instinct  may  become  by  culti- 
vation highly  specialized  and  associated  with  normally 
indifferent  objects,  giving  rise  to  the  various  phobias, 
such  as  astrophobia,  agoraphobia,  claustrophobia,  ery- 
throphobia,  aichmophobia,  and  other  phobias,  according 
to  the  objects  with  which  the  fear  instinct  becomes  as- 
sociated. Objects,  otherwise  indifferent  and  even  pleas- 
ant, may  by  association  arouse  the  fear  instinct  and 
give  rise  to  morbid  states,  like  the  "conditional  reflexes" 
in  Pavloff's  animals. 


435044 


CHAPTERIV 

EMBRYONIC    PERSONALITY  AND    PSYCHOPATHIC 
AFFECTIONS 

THERE  is  another  factor  which  helps  to  arouse 
the  fear  instinct,  and  thus  plays  an  important 
role  in  the  causation  of  psychopathic  maladies. 
This  factor  is  a  narrow^  suggestible  personal 
life.  In  my  work  ^^  The  Psychology  of  Suggestion," 
I  proved  by  a  series  of  experiments  that  the  conditions 
of  suggestibility  are:  Fixation  of  attention,  monotony, 
limitation  of  voluntary  movements,  limitation  of  the 
field  of  consciousness,  inhibition.  I  have  shown  that 
these  conditions  are  favorable  to  disaggregation  of 
consciousness.  I  have  pointed  out  that  a  disaggrega- 
tion of  consciousness  with  an  inhibition  of  the  con- 
troUing,  waking  consciousness  is  one  of  the  important 
conditions  in  the  causation  of  subconscious  states  with 
their  accompanying  abnormal  suggestibility.  In  other 
words,  the  inhibition  of  the  personal  self,  or  even  the 
limitation  of  the  personal  self,  helps  the  formation  of 
dissociations  which  constitute  the  soil  of  all  psycho- 
pathic diseases.  When  the  person,  therefore,  is  limited 
in  his  interests,  is  narrow  in  his  range  of  knowledge,  is 
ignorant  and  superstitious,  and  his  critical  personal  self 
is  embryonic  and  undeveloped,  the  predisposition  to 
mental  disaggregation  is  pronounced.  The  fear  instinct 
has  full  sway  in  the  production  of  psychopathic  states. 
With  the  limitation  and  inhibition  of  the  critical  per- 
sonal self,  with  the  limitation  and  narrowness  of  per- 
sonal life  interests,  there  goes  an  increase  of  the  sense  of 
the  unknown  and  the  mysterious,  cultivated  by  religion 
and  superstition,  with  the  baneful  consequence  of  the 

38 


Embryonic  Personality  and  Psychopathic  Affections  39 

development  of  the  fear  instinct, — the  cause  of  psycho- 
pathic affections. 

In  the  embryonic  personahty  of  the  child  as  well  as 
in  the  undeveloped  or  narrowed  individuality  of  the 
adult  the  sense  of  the  strange,  of  the  unknown  and  the 
mysterious,  is  especially  apt  to  arouse  the  fear  instinct. 
In  fact,  the  unfamiliar  arouses  the  fear  instinct  even  in 
the  more  highly  organized  mind.  "Any  new  uncer- 
tainty," says  Bain,  "is  especially  the  cause  of  terror. 
We  become  habituated  to  a  frequent  danger,  and  realize 
the  full  force  of  apprehension  only  when  the  evil  is 
previously  unknown.  Such  are  the  terrors  caused 
by  epidemics,  the  apprehensions  from  an  unexperienced 
illness,  the  feeling  of  a  recruit  under  fire.  .  .  .  The 
mental  system  in  infancy  is  highly  susceptible,  not 
merely  to  pain,  but  to  shocks  and  surprises.  Any 
great  excitement  has  a  perturbing  effect  allied  to  fear. 
After  the  child  has  contracted  a  familiarity  with  the 
persons  and  things  around  it,  it  manifests  unequivocal 
fear  on  the  occurrence  of  anything  very  strange.  The 
grasp  of  an  unknown  person  often  gives  a  fright.  This 
early  experience  very  much  resembles  the  manifesta- 
tions habitual  to  the  inferior  animals."  In  another 
place  Bain  rightly  says,  "Our  position  in  the  world 
contains  the  sources  of  fear.  The  vast  powers  of  nature 
dispose  of  our  lives  and  happiness  with  irresistible 
might  and  awful  aspect.  Ages  had  elapsed  ere  the 
knowledge  of  law  and  uniformity  prevailing  among 
those  powers  was  arrived  at  by  the  human  intellect. 
The  profound  ignorance  of  the  primitive  man  (and,  we 
may  add,  of  the  undeveloped,  limited^  and  superstitious 
adult)  was  the  soil  wherein  his  early  conceptions  and 
theories  sprang  up;  and  the  fear  inseparable  from 
ignorance  gave  them  their  character.  The  essence  of 
superstition  is  expressed  by  the  definition  of  fear.  An 
altogether  exaggerated  estimate  of  things,  the  ascription 


40       Causation  and   Treatment,  Psychopathic  Diseases 

of  evil  agency  to  the  most  harmless  objects,  and  false 
apprehensions  everywhere,  are  among  the  attributes 
of  the  superstitious  man." 

Compayre,  in  speaking  of  the  fear  of  the  child,  says, 
"In  his  limited  experience  of  evil,  by  a  natural  generali- 
zation, he  suspects  danger  everywhere,  like  a  sick  person 
whose  aching  body  dreads  in  advance  every  motion 
and  every  contact.  He  feels  that  there  is  a  danger 
everywhere,  behind  the  things  that  he  cannot  under- 
stand, because  they  do  not  fit  in  with  his  experience. 
The  observations  collected  by  Romanes  in  his  interest- 
ing studies  on  the  intelligence  of  animals  throw  much 
light  on  this  question;  they  prove  that  dogs,  for  instance, 
do  not  fear  this  or  that,  except  as  they  are  ignorant  of 
the  cause.  A  dog  was  very  much  terrified  one  day  when 
he  heard  a  rumbling  like  thunder  produced  by  throwing 
apples  on  the  floor  of  the  garret;  he  seemed  to  under- 
stand the  cause  of  the  noise  as  soon  as  he  was  taken 
to  the  garret,  and  became  as  quiet  and  happy  as  ever. 
Another  dog  had  a  habit  of  playing  with  dry  bones. 
One  day  Romanes  attached  a  fine  thread  which  could 
hardly  be  seen,  to  one  of  the  bones,  and  while  the  dog 
was  playing  with  it,  drew  it  slowly  toward  him;  the 
dog  recoiled  in  terror  from  the  bone,  which  seemed  to 
be  moving  of  its  own  accord.  So  skittish  horses  show 
fright  as  long  as  the  cause  of  the  noise  that  frightens 
them  remains  unknown  and  invisible  to  them.  It  is 
the  same  with  the  child.  When  in  the  presence  of  all 
these  things  around  him,  of  which  he  has  no  idea,  these 
sounding  objects,  these  forms,  these  movements,  whose 
cause  he  does  not  divine,  he  is  naturally  a  prey  to  vague 
fears.  He  is  just  what  we  should  be  if  chance  should 
cast  us  suddenly  into  an  unexplored  country  before 
strange  objects  and  strange  beings — suspicious,  always 
on  the  qui  vive,  disposed  to  see  imaginary  enemies  be- 


Embryonic  Personality  and  Psychopathic  Affections     41 

hind  every  bush,  fearing  a  new  danger  at  every  turn  in 
the  road." 

Similarly,  Sully  says,  "The  timidity  of  childhood  is 
seen  in  the  readiness  with  which  experience  invests 
objects  and  places  with  a  fear-exciting  aspect,  in  its 
tendency  to  look  at  all  that  is  unknown  as  terrifying 
and  in  the  difficulty  of  the  educator  in  controlling  these 
tendencies. "  Sully  is  right  in  thinking  that  intellectual 
culture  tends  greatly  to  reduce  the  early  intensity  of 
fear.  "This  it  does  by  substituting  knowledge  for 
ignorance,  and  so  undermining  that  vague  terror  before 
the  unknown  to  which  the  child  and  the  superstitious 
savage  are  a  prey,  an  effect  aided  by  the  growth  of  will 
power  and  the  attitude  of  self-confidence  which  this 
brings  with  it."  An  uncultivated  personality  with  a 
limited  mental  horizon,  with  a  narrow  range  of  interests, 
a  personality  sensitive  to  the  moral  categorical  impera- 
tive, a  personality  trained  in  the  fear  of  the  Lord  and 
mysterious  agencies,  is  a  fit  subject  for  obsessions  by 
the  fear  instinct. 

In  certain  types  of  functional  psychosis  and  neurosis 
the  patient  has  an  inkling  of  the  fear  instinct  in  his 
dread  of  objects,  or  of  states  of  mind,  moral  scruples, 
lack  of  confidence,  blushing,  religious  or  social  expecta- 
tions of  some  coming  misfortune  and  some  mysterious 
evil,  but  he  is  not  aware  of  the  fear  instinct  as  developed 
in  him  by  the  events  and  training  of  early  childhood. 
The  fears  of  early  childhood  are  subconscious.  At  any 
rate,  the  patient  does  not  connect  them  with  his  present 
mental  affection.  In  other  types  of  psychopathic 
affections  the  patient  is  entirely  unaware  of  the  whole 
situation,  he  is  engrossed  by  the  symptoms  which  he 
regards  as  the  sum  and  substance  of  his  trouble;  the 
fear  is  entirely  subconscious. 

The  fear  instinct  fostered  by  frights,  scares,  dread 
of  sickness,  by  religious  instruction  with  its  fear  of  the 


42       Causation  and   Treatment^  Psychopathic  Diseases 

Lord,  by  moral  and  religious  injunctions  and  duties 
with  fear  of  punishment  or  failure  in  the  moral  stand- 
ard and  duties,  the  enforcement  of  social  injunctions 
with  the  consequent  dread  of  failure  and  degradation, 
— all  go  to  the  cultivation  of  the  fear  instinct  which  in 
later  life  becomes  manifested  as  functional  psychosis 
with  all  its  baneful  effects.  Thus  a  psychoneurotic  in  his 
account  writes:  "I  dwell  on  my  childish  acts  because 
of  my  religious  training,  because  of  the  superstitions 
charged  with  religious  and  pseudo-moral  emotions." 
The  fear  of  the  Lord,  especially  when  cultivated  in 
early  childhood,  is  not  only  as  the  Bible  has  it,  "the 
beginning  of  (religious)  wisdom,"  but  is  also  the  be- 
ginning of  morbid  mental  states,  the  source  of  psycho- 
pathic affections. 

As  Bacon  puts  it: 

"Natura  enim  rerum  omnibus  viventibus  indidit  metum 
ac  formidinem,  vitce  atque  essentia  suce  conservatricem,  ac 
mala  ingruentia  vitantem  et  depellentem.  Verumtamen  eadem 
natura  modum  tenere  nescia  est,  sed  timoribus  salutaribus 
semper  vanos  et  inanes  admiscet;  adeo  ut  omnia — {si  intus 
conspici  darentur)  Panicis  terroribus  plenissima  sint,  prae- 
sertim  humana." 


CHAPTER  V 

THE    FEAR    INSTINCT   AND    PSYCHOPATHIC    STATES 

THE  fear  instinct  is  the  soil  on  which  grow 
luxuriantly  the  infinite  varieties  of  psycho- 
pathic affections.  The  body,  sense,  intellect, 
and  will  are  all  profoundly  affected  by  the 
irresistible  sweep  of  the  fear  instinct  as  manifested  in 
the  overwhelming  feeling  of  anxiety.  The  fear  instinct 
and  its  offspring — anxiety — weaken,  dissociate,  and 
paralyze  the  functions  of  the  body  and  mind,  giving 
rise  to  the  various  symptoms  of  psychopathic  diseases. 
The  fear  instinct  keeps  on  gnawing  at  the  very  vitals 
of  the  psychopathic  patient.  Even  at  his  best  the 
psychopathic  patient  is  not  free  from  the  workings  of 
the  fear  instinct,  from  the  feeling  of  anxiety  which, 
as  the  patients  themselves  put  it,  "hangs  like  a  cloud 
on  the  margin  or  fringe  of  consciousness. "  From  time 
to  time  he  can  hear  the  distant,  threatening  rumbling 
of  the  fear  instinct.  Even  when  the  latter  is  apparently 
stilled  the  pangs  of  anxiety  torment  the  patient  like 
a  dull  toothache. 

Montaigne,  the  great  anatomist  of  human  passions, 
in  writing  of  fear,  says,  "I  am  not  so  good  a  naturalist 
(as  they  call  it)  as  to  discern  by  what  secret  springs 
fear  has  its  motion  in  us;  but  be  this  as  it  may,  it  is  a 
strange  passion,  and  such  a  one  as  the  physicians  say 
there  is  no  other  whatever  that  sooner  dethrones  oiir 
judgment  from  Its  proper  seat;  which  is  so  true,  that 
I  myself  have  seen  very  many  become  frantic  through 
fear;  and  even  in  those  of  the  best  settled  temper,  it  is 
most  certain  that  it  begets  a  terrible  astonishment  and 
confusion  during  the  fit.     I  omit  the  vulgar  sort,  to 

43 


44       Causation  and   Treatment,  Psychopathic  Diseases 

whom  it  one  while  represents  their  great-grandsires 
risen  out  of  their  graves  in  their  shrouds,  another  while 
hobgoblins,  specters,  and  chimeras;  but  even  among 
soldiers,  a  sort  of  men  over  whom,  of  all  others,  it  ought 
to  have  the  least  power,  how  often  has  it  converted 
flocks  of  sheep  into  armed  squadrons,  reeds  and  bull- 
rushes  into  pikes  and  lances,  and  friends  into  enemies 

.     adeo  pavor  etiam  auxilia  formidat. 
The  thing  in  the  world  I  am  most  afraid  of  is  fear,  that 
passion  alone,  in  the  trouble  of  it,  exceeding  all  other 

accidents Turn  pavor  sapientiam   omnem 

mihi  ex  animo  expectorat.  Such  as  have  been  well 
banged  in  some  skirmish,  may  yet,  all  wounded  and 
bloody  as  they  are,  be  brought  on  again  the  next  day 
to  the  charge;  but  such  as  have  once  conceived  a  good 
sound  fear  of  the  enemy  will  never  be  made  so  much 
as  to  look  the  enemy  in  the  face.  Such  as  are  in  im- 
mediate fear  of  losing  their  estates,  of  banishment  or 
of  slavery,  live  in  perpetual  anguish,  and  lose  all  appe- 
tite and  repose;  whereas  such  as  are  actually  poor, 
slaves  or  exiles,  ofttimes  live  as  merrily  as  other  folks. 
And  the  many  people  who,  impatient  of  perpetual 
alarms  of  fear,  have  hanged  or  drowned  themselves,  or 
dashed  themselves  to  pieces,  give  us  sufficiently  to 
understand  that  fear  is  more  importunate  and  insup- 
portable than  death  itself." 

In  the  present  fearful  war  of  European  nations 
against  the  pressure  of  invasion  by  Teutons  and  their 
allies,  a  war  unparalleled  in  the  history  of  humanity 
for  its  extensive,  brutal  destructiveness,  a  war  in  which 
all  the  inventions  of  ages  are  made  subservient  to  the 
passions  of  greed,  hatred,  and  ferocity,  having  one 
purpose,  the  extermination  of  man,  a  war  surpassing 
all  battles  ever  waged  by  man  or  beast,  in  such  a  calami- 
tous clash  and  slaughter  of  nations,  the  fear  instinct 
comes  to  the  foreground,  claiming  its  victims,  working 


The  Fear  Instinct  and  Psychopathic  States         45 

havoc  among  the  frenzied,  struggling  armed  masses 
and  terrified,  stricken  populations. 

That  fear  is  a  fundamentally  important  element  in 
neuroses  and  psychoses  has  been  fully  acknowledged 
by  many  a  neurologist  and  psychiatrist.  Thus,  Oppen- 
heim  says,  "Fear  is  a  common  symptom  in  the  neuroses. 
It  may  be  an  indefinite  feeling  of  anxiety  not  awakened 
by  any  particular  cause,  or  it  may  be  definite  concepts 
and  external  influences  which  call  the  fear  into  action. 
The  sensation  is  variously  described.  It  has  its  seat, 
as  a  rule,  in  the  cardiac  region,  at  other  times  in  the 
head.  The  patient  feels  as  if  his  heart  were  standing 
still;  he  thinks  that  he  must  fall  or  that  he  will  get  a 
stroke.  Some  explain  the  condition  thus:  Tt  seems 
to  me  that  I  have  done  something  wrong,  as  if  some- 
thing terrible  is  going  to  happen.'  The  expression  of 
the  face  reveals  a  condition  of  anxiety,  the  fear  often 
producing  vasomotor,  secretory,  and  motor  disturb- 
ances; the  face  reddens  or  becomes  pallid,  perspiration 
breaks  out,  the  saliva  ceases  to  flow,  the  lips  and  tongue 
become  dry,  the  pulse  and  respiration  become  acceler- 
ated." 

"A  materially  different  picture,"  says  Kirchoff, 
"  is  presented  when  the  feeling  of  fear  enters  the  symp- 
tom group  (of  melancholia).  This  feeling  is  referred 
to  the  cardiac  region  (precordial  fear),  and  is  one  oj 
the  most  important  and  frequent  accompaniments  of 
severe  melancholia.  The  external  quiet  of  severe  simple 
melancholia  becomes  converted  into  anxious  restless- 
ness. From  the  start  sleep  is  almost  always  disturbed 
because  the  patient  is  tormented  by  the  pressure  in  the 
cardiac  region.  Other  disagreeable  sensations  soon 
follow,  such  as  constriction  of  the  neck  or  a  dull  feeling 
in  the  head;  bad  dreams  and  anxious  thoughts  become 
more  numerous.  The  daily  work  may  make  the  con- 
dition endurable  during  the  day  for  a  time,  but  in  the 


46       Causation  and  Treatment,  Psychopathic  Diseases 

stillness  of  the  night  it  is  rapidly  intensified,  and  if  sleep 
does  not  refresh  the  excited  brain,  the  days  likewise 
are  filled  more  and  more  with  disheartening  fears. 
The  implication  of  the  organs  of  the  body  is  much  more 
distinct  in  anxious  than  in  simple  melancholia.  The 
appetite  is  lost,  the  nutrition  is  rapidly  impaired. 
Respiration  is  superficial,  the  heart's  action  is  accelerat- 
ed and  often  irregular,  the  pulse  is  small,  the  skin  is 
cool.  When  the  terror  shows  variations  or  occurs  in 
paroxysms,  its  increase  is  shown  by  suppression  of  the 
urine  and  perspiration,  its  subsidence  by  increase  in 
these  secretions.  The  more  chronic  the  precordial  fear 
the  more  indistinct  do  these  symptoms  become.  .  . 
.  .  Religious  notions  are  often  awakened  and  are 
then  explained  as  the  dread  of  being  possessed  by  evil 
spirits.  ...  In  more  severe  cases  the  internal  life 
becomes  a  real  dreamy  condition  in  which  external 
expressions  are  received  in  a  confused,  shadowy  and 
inimical  manner.  A  terrible,  baseless,  but  paralyzing 
fear  takes  possession  of  consciousness."  The  anxiety 
states  of  neurosis  and  psychosis  are  essentially  due  to 
the  awakening  of  the  fear  instinct  normally  present  in 
every  living  being.  The  fear  instinct  is  a  fundamental 
one;  it  is  only  inhibited  by  the  whole  course  of  civiliza- 
tion and  by  the  training  and  education  of  social  life. 
Like  the  jinn  of  the  "Arabian  Nights,"  it  slumbers  in 
the  breast  of  every  normal  individual,  and  comes  fully 
to  life  in  the  various  neuroses  and  psychoses. 

Kraepelin  and  his  school  lay,  with  right,  special  stress 
on  the  fact  that  "Fear  is  by  far  the  most  important 

persistent    emotion   in   morbid    conditions 

Fear  is  manifested  by  anxious  excitement  and  by  anx- 
ious tension."  "Experience,"  says  Kraepelin,  "shows 
an  intimate  relationship  between  insistent  psychosis 
and  the  so-called  'phobias,'  the  anxiety  states  which  in 
such  patients  become  associated  with  definite  impres- 


The  Fear  Instinct  and  Psychopathic  States        47 

sions,  actions,  and  views."  They  are  associated  with 
the  thought  of  some  great  unknown  danger,  although 
the  patient  may  be  aware  that  in  reaHty  nothing  of  the 
kind  will  befall  him.  Violent  heart  action,  pallor,  a 
feeling  of  anxiety,  tremor,  cold  sweat,  meteorismus, 
diarrhea,  polyuria,  weakness  in  the  legs,  attacks  of 
fainting,  so  that  the  patient  loses  control  of  his  limbs 
and  occasionally  simply  collapses.  "These  states," 
says  Kraepelin,  with  his  usual  insight  into  abnormal 
mental  life,  "remind  one  of  the  feeling  of  anxiety  which 
in  the  case  of  healthy  people  may  in  view  of  a  painful 
situation  or  of  a  serious  danger  deprive  one  of  the  calm- 
ness of  judgment  and  confidence  in  his  movements." 
Thus,  we  find  from  different  standpoints  that  the  feel- 
ing of  anxiety  with  all  its  accompanying  phenomena 
is  one  of  the  manifestations  of  the  most  fundamental, 
the  most  potent,  of  animal  instincts,  the  fear  instinct 
which  is  at  the  basis  of  all  psychopathic  maladies. 

The  fear  instinct,  as  the  most  subtle  and  most  funda- 
mental of  all  instincts,  is  well  described  by  Kipling: — • 

"  Very  softly  down  the  glade  runs  a  waiting,  watching  shade, 
And  the  whisper  spreads  and  widens  far  and  near; 

And  the  sweat  is  on  thy  brow,  for  he  passes  even  now — 
He  is  Fear,  O  Little  Hunter,  he  is  Fear! 

"  Ere  the  moon  has  climbed  the  mountain,  ere  the  rocks  are 
ribbed  with  light, 
When  the  downward  dipping  trails  are  dank   and    drear. 
Comes  a  breathing  hard  behind  thee — smijffie — snuffle  through 
the  night; 
It  is  Fear,  O  Little  Hunter,  it  is  Fear! 

"On  thy  knees  and  draw  the  bow;  bid  the  shrilling  arrow  go: 
In  the  empty,  mocking  thicket  plunge  the  spear; 

But  thy  hands  are  loosed  and  weak,  and  the  blood  has  left 
thy  cheek — 
It  is  Fear,  O  Little  Hunter,  it  is  Fear! 


48       Causation  and  Treatment,  Psychopathic  Diseases 

"When  the  heat-cloud  sucks  the  tempest,  when  the  slivered 
pine  trees  fall, 
When  the  blinding,   blaring   rain-squalls   lash   and  veer; 
Through  the  war  gongs  of  the  thunder  rings  a  voice  more 
loud  than  all — 
It  is  Fear,  O  Little  Hunter,  it  is  Fear! 

"Now  the  spates    are  banked  and  deep;    now  the  footless 
boulders  leap — 
Now  the  lightning  shows  each  littlest  leaf-rib  clear. 
But  thy  throat  is  shut  and  dried,  and  thy  heart  against 
thy  side 
Hammers:  Fear,  O  Little  Hunter, — ^This  is  Fear!" 

A  well  known  author,  a  psychopathic  sufferer,  writes : 

"Carlyle  laid  his  finger  upon  the  truth,  when  he 
said  that  the  reason  why  the  pictures  of  the  past  were 
always  so  golden  in  tone,  so  delicate  in  outline,  was  be- 
cause the  quality  of  fear  was  taken  from  them.  It  is 
the  fear  of  what  may  be  and  what  must  be  that  over- 
shadows present  happiness;  and  if  fear  is  taken  from  us 
we  are  happy.  The  strange  thing  is  that  we  cannot 
learn  not  to  be  afraid,  even  though  all  the  darkest  and 
saddest  of  our  experiences  have  left  us  unscathed;  and 
if  we  could  but  find  a  reason  for  the  mingling  of  fear 
with  our  lives,  we  should  have  gone  far  towards  solving 
the  riddle  of  the  world. " 

Dr.  Crile  lays  special  stress  on  the  pathological  aspect 
of  the  fear  instinct: 

"That  the  brain  is  definitely  influenced — damaged 
even — by  fear  has  been  proved  by  the  following  ex- 
periments: Rabbits  were  frightened  by  a  dog  but  were 
neither  injured  nor  chased.  After  various  periods  of 
time  the  animals  were  killed  and  their  brain-cells  com- 
pared with  the  brain-cells  of  normal  animals — wide- 
spread changes  were  seen.  The  principal  clinical 
phenomena  expressed  by  the  rabbit  were  rapid  heart, 
accelerated    respiration,    prostration,    tremors,    and    a 


The  Fear  Instinct  and  Psychopathic  States       49 

rise  in  temperature.  The  dog  showed  similar  phenom- 
ena, excepting  that,  instead  of  such  muscular  relaxa- 
tion as  was  shown  by  the  rabbit,  it  exhibited  aggressive 
muscular  action.  Both  the  dog  and  the  rabbit  were 
exhausted  but,  although  the  dog  exerted  himself  active- 
ly and  the  rabbit  remained  physically  passive,  the 
rabbit  was  much  more  exhausted. 

"Further  observations  were  made  upon  the  brain  of 
a  fox  which  had  been  chased  for  two  hours  by  members 
of  a  hunt  club,  and  had  been  finally  overtaken  by  the 
hounds  and  killed.  Most  of  the  brain-cells  of  the  fox, 
as  compared  with  those  of  a  normal  fox,  showed  exten- 
sive physical  changes. 

"The  next  line  of  evidence  is  offered  with  some 
reservation,  but  it  has  seemed  to  me  to  be  more  than 
mere  idle  speculation.  It  relates  to  the  phenomena 
of  one  of  the  most  interesting  diseases  in  the  entire 
category  of  human  ailments — I  refer  to  exophthalmic 
goiter,  or  Graves'  disease,  a  disease  primarily  involving 
the  emotions.  This  disease  is  frequently  the  direct 
sequence  of  severe  mental  shock  or  of  a  long  and  in- 
tensely worrying  strain.  The  following  case  is  typical: 
A  broker  was  in  his  usual  health  up  to  the  panic  of 
1907;  during  this  panic  his  fortune  and  that  of  others 
were  for  almost  a  year  in  jeopardy,  failure  finally 
occurring.  During  this  heavy  strain  he  became  increas- 
ingly nervous  and  by  imperceptible  degrees  there 
developed  a  pulsating  enlargement  of  the  thyroid 
gland,  an  increased  prominence  of  the  eyes,  marked 
increase  in  perspiration — profuse  sweating  even — 
palpitation  of  the  heart,  increased  respiration  with 
frequent  sighing,  increase  in  blood-pressure;  there  were 
tremor  of  many  muscles,  rapid  loss  of  weight  and 
strength,  frequent  gastro-intestinal  disturbances,  loss 
of  normal  control  of  his  emotions,  and  marked  impair- 
ment of  his  mental  faculties.     He  was  as  completely 


50       Causation  and   Treatment,   Psychopathic  Diseases 

broken  In  health  as  in  fortune.  These  phenomena 
resembled  closely  those  of  fear  and  followed  in  the  wake 
of  a  strain  which  was  due  to  fear. " 

Animals  in  which  the  fear  instinct  can  be  aroused 
to  a  high  degree  become  paralyzed  and  perish.  Under 
such  conditions  the  fear  instinct  not  only  ceases  to  be 
of  protective  value,  but  is  the  very  one  that  brings 
about  the  destruction  of  the  animal  obsessed  by  it. 
"One  of  the  most  terrible  effects  of  fear,"  says  Mosso, 
"is  the  paralysis  which  allows  neither  of  escape  nor  of 
defense."  The  fear  instinct  is  no  doubt  one  of  the 
most  vital  of  animal  instincts,  but  when  it  rises  to  a 
high  degree  of  intensity,  or  when  it  is  associated  with 
familiar  ■  and  useful  objects  instead  of  strange  and 
harmless  objects,  then  we  may  agree  with  the  great 
physiologist,  Haller,  that  the  phenomena  of  fear  are 
not  aimed  at  the  preservation,  but  at  the  destruction 
of  the  animal,  or  as  Darwin  puts  it,  are  of  "disservice 
to  the  animal."  This  is  just  the  condition  found  in 
psychopathic  diseases.  The  fear  instinct  becomes 
aroused  in  early  life  and  cultivated  by  training,  educa- 
tion, and  environment,  becoming  associated  in  later 
life  with  particular  events,  objects,  and  special  states. 

When  the  instinct  of  fear  is  aroused  in  connection 
with  some  future  impending  misfortune,  the  feeling  of 
expectation  and  all  its  psychological  changes,  mus- 
cular, respiratory,  cardiac,  epigastric,  and  .  intes- 
tinal, go  to  form  that  complex  state  of  anxiety  and 
anguish,  so  highly  characteristic  of  acute  varieties  of 
psychopathic  disease.  When  fear  reaches  its  acme,  the 
heart  is  specially  affected,  the  circulatory  and  respira- 
tory changes  become  prominent,  and  give  rise  to 
oppression  and  depression  which  weigh  like  an  incubus 
on  the  patient — the  feeling  known  as  "precordial 
anxiety. " 


The  Fear  Instinct  and  Psychopathic  States        51 

The  fear  instinct  is  the  ultimate  cause  of  the  infinite 
varieties  of  psychopathic  diseases. 

Stanley  Hall  seems  to  accept  this  view  of  the 
subject.  In  his  recent  paper  on  Fear,  he  writes:  "If 
there  be  a  vital  principle,  fear  must  be  one  of  its  close 
allies  as  one  of  the  chief  springs  of  the  mind.  .  .  " 
In  spite  of  his  former  "psychoanalytic"  inclinations, 
Professor  Hall  now  asserts  that  "Freud  is  wrong  in 
interpreting  this  most  generic  form  of  fear  as  rooted  in 
sex.  .  .  Sex  anxieties  are  themselves  rooted  in  the 
larger  fundamental  impulse  of  preservation  of  life  with 
its  concomitant  instinct  of  fear. "  This  is  the  etiology 
on  which  I  laid  stress  in  my  papers  and  works  on  the 
subject  of  psychopathic  diseases.  So  deeply  convinced 
is  Professor  Stanley  Hall  of  the  primitive  and  funda- 
mental character  of  the  fear  instinct,  that  he  refers  to 
the  facts  that  "if  the  cerebrum  is  removed,  animals,  as 
Goltz  and  Bechterev  have  proved,  manifest  very  intense 
symptoms  of  fear,  and  so  do  human  monsters  born 
without  brains,  or  hemicephalic  children,  as  Sternberg 
and  Lotzko  have  demonstrated." 

Oppenheim,  Kirchoff,  Kraepelin,  and  recently  other 
psychologists  and  neurologists  of  note  all  concur  that 
fear  is  a  fundamental  factor  in  the  pathology  of  neurosis. 
As  physicians,  we  must  remember  the  importance  of 
fear  in  cases  of  surgical  shock. 

So  potent,  all  embracing,  and  all  pervading  is  the 
fear  instinct,  that  the  physician  must  reckon  with  it 
in  his  private  office,  in  the  hospital,  and  in  the  surgical 
operating  room. 

"The  acute  fear  of  a  surgical  operation"  Crile  writes, 
"may  be  banished  by  the  use  of  certain  drugs  that 
depress  the  associational  power  of  the  brain  and  so 
minimise  the  effect  of  the  preparations  that  usually 
inspire  fear.  If,  in  addition,  the  entire  field  of  opera- 
tion is  blocked  by  local  anesthesia  so  that  the  associa- 


52       Causation  and   Treatment^  Psychopathic  Diseases 

tional  centers  are  not  awakened,  the  patient  will  pass 
through  the  operation  unscathed." 

In  a  number  of  my  cases  psychognosis  clearly  reveals 
the  fact  that  even  where  the  neurosis  has  not  originated 
in  a  surgical  trauma,  surgical  operations  reinforced, 
developed,  and  fixed  psychopathic  conditions. 

The  fear  instinct  arises  from  the  impulse  of  self- 
preservation  without  which  animal  life  cannot  exist. 
The  fear  instinct  is  one  of  the  most  primitive  and  most 
fundamental  of  all  instincts.  Neither  hunger,  nor 
sex,  nor  maternal  instinct,  nor  social  instinct  can  com- 
pare with  the  potency  of  the  fear  instinct,  rooted  as  it 
is  in  self  preservation, — the  condition  of  life  primodial. 
When  the  instinct  of  fear  is  at  its  height,  it  sweeps 
before  it  all  other  instincts.  Nothing  can  withstand 
a  panic.  Functional  psychosis  in  its  full  development 
is  essentially  a  panic.  A  psychogenetic  examination 
of  every  case  of  functional  psychosis  brings  one  in- 
variably to  the  fundamental  fear  instinct.  Fear  is  the 
guardian  instinct  of  life.  The  intensity  of  the  struggle 
for  existence,  the  preservation  of  life  of  the  animal,  is 
expressed  in  the  instinct  of  fear.  The  fear  instinct 
in  its  mild  form,  when  connected  with  what  is  strange 
and  unfamiliar,  or  with  what  is  really  dangerous  to  the 
animal,  is  of  the  utmost  consequence  to  life. 

What  is  strange  and  unfamiliar  may  be  a  menace 
to  life,  and  it  is  a  protection,  if  under  such  conditions 
the  fear  instinct  is  aroused.  It  is  again  of  the  utmost 
importance  in  weak  animals,  to  have  the  fear  instinct 
easily  aroused  by  the  slightest  strange  stimulus;  the 
animal  is  defenseless,  and  its  refuge,  its  safety,  is  in 
running.  The  unfamiliar  stimulus  may  be  a  signal  of 
danger,  and  it  is  safer  to  get  away  from  it;  the  animal 
cannot  take  chances.  On  the  other  hand,  animals 
that  are  too  timid,  so  that  even  the  familiar  becomes 
too  suspicious,  cannot  get  their  food  and  cannot  leave 


The  Fear  Instinct  and  Psychopathic  States        53 

progeny, — they  become  eliminated  by  the  process  of 
natural  selection.  Even  in  weak  animals  an  intensified 
state  of  the  fear  instinct  becomes  biologically  abnormal, 
pathological. 

The  fear  instinct  is  abnormally  developed  in  psy- 
chopathic disturbances.  Harmful  stimuli  or  expecta- 
tion of  danger  to  themselves,  to  their  family,  or  to 
friends  may  arouse  the  feelings  of  anguish,  anxiety, 
worry,  manifestations  of  the  fear  instinct.  Objects, 
thoughts,  stimuli,  situations,  and  events  of  expected 
danger  may  keep  on  changing,  persisting  for  a  longer 
or  shorter  time,  but  the  underlying  pathological  state 
of  the  fear  instinct  remains,  easily  fusing  with  exper- 
iences of  possible  danger  to  all  included  within  the 
circle  of  the  patient's  self-regard. 

Events  or  situations  with  fixed  sensory  stimuli,  when 
repeated,  fix  the  neurosis,  very  much  in  the  same  way 
as  are  the  "conditional  reflexes"  in  Pavloff's  experi- 
ments. Other  sets  of  stimuli  of  an  ideational  character 
are  transient  in  duration,  while  the  general,  apprehen- 
sive, subconscious  condition  persists  unchanging  to 
seize  again  and  again  on  ever  new  objects  and  thoughts, 
forming  psychic  compounds  of  various  degrees  of 
stability. 


CHAPTER  VI 

MANIFESTATIONS    OF    FEAR   INSTINCT 
AND    SYMPTOMS    OF    PSYCHOPATHIC    DISEASES 

IF  we  examine  closely  the  symptoms  of  fear,  we 
invariably  find  the  symptoms  of  functional 
psychosis.  Fear  affects  the  muscular  and  sensory 
systems,  the  vasomotor  system,  the  respiratory 
system,  the  sudorific  glands,  the  viscera,  the  heart,  the 
intestines,  etc.  Bain,  in  describing  the  emotions  of 
fear  or  terror,  says  "The  appearances  may  be  dis- 
tributed. Terror  on  the  physical  side  shows  both  a  loss 
and  a  transfer  of  nervous  energy.  The  appearances 
may  be  distributed  between  the  effects  of  relaxation 
and  effects  of  tension.  The  relaxation  is  seen,  as 
regards  the  muscles,  in  the  dropping  of  the  jaw,  in  the 
collapse  overtaking  all  organs  not  specially  excited,  in 
trembling  of  the  lips  and  other  parts,  and  in  the  loosen- 
ing of  the  sphincters.  Next,  as  regards  the  organic 
processes  and  viscera.  The  digestion  is  everywhere 
weakened;  the  flow  of  saliva  is  checked,  the  gastric 
secretion  arrested  (appetite  failing),  the  bowels  de- 
ranged; the  expiration  is  enfeebled.  The  heart  and  cir- 
culation are  disturbed;  there  is  either  a  flushing  of  the 
face  or  a  deadly  pallor.  The  skin  shows  symptoms — 
the  cold  sweat,  the  altered  odor  of  the  perspiration, 
the  creeping  action  that  lifts  the  hair.  The  kidneys  are 
directly  or  indirectly  affected.  The  sexual  organs  feel 
the  depressing  influence.  The  secretion  of  milk  in  the 
mother's  breast  is  vitiated. " 

Darwin  gives  the  following  description  of  fear: — 
"The  frightened  man  at  first  stands  like  a  statue 
motionless  and  breathless,  or  crouches  down  as  if  to 
escape  observation.  The  heart  beats  quickly  and 
violently;  but  it  is  very  doubtful  if  it  then  works  more 

54 


Fear  Instinct^  Symptoms  of  Psychopathic  Diseases     5  5 

efficiently  than  usual  so  as  to  send  a  greater  supply  of 
blood  to  the  body;  for  the  skin  instantly  becomes  pale, 
as  during  incipient  faintness.  The  paleness  of  the 
surface,  however,  is  probably  in  large  part  or  is  ex- 
clusively due  to  the  vasomotor  center  being  affected  in 
such  a  manner  as  to  cause  the  contraction  of  the  small 
arteries  of  the  skin.  That  the  skin  is  much  affected 
under  the  sense  of  great  fear  we  see  in  the  marvelous 
manner  in  which  the  perspiration  immediately  exudes 
from  it.  This  exudation  is  all  the  more  remarkable 
as  the  surface  is  then  cold,  and  hence  the  term,  a  cold 
sweat;  whereas  the  sudorific  glands  are  properly  excited 
into  action  when  the  surface  is  heated.  The  hairs  also 
on  the  skin  stand  erect,  and  the  superficial  muscles 
shiver.  In  connection  with  the  disturbed  action  of 
the  heart  the  breathing  is  hurried.  The  salivary  glands 
act  imperfectly;  the  mouth  becomes  dry  and  is  often 
opened  and  shut.  I  have  also  noticed  that  under  slight 
fear  there  is  a  slight  tendency  to  yawn.  One  of  the  best 
symptoms  is  the  trembling  of  all  the  muscles  of  the  body. 
From  this  cause  and  from  the  dryness  of  the  mouth,  the 
voice  becomes  husky  or  indistinct,  or  may  altogether  fail." 

If  we  turn  now  to  the  manifestations  of  psychopathic 
maladies,  we  meet  with  the  same  symptoms: — 

{a)  The  attacks  may  be  muscular,  Involving  symp- 
toms such  as  trembling,  shaking,  paresis,  paralysis,  or 
rigidity;  there  may  be  affection  of  locomotion  or  of 
muscular  co-ordination. 

{h)  There  may  be  sensory  disturbances, — anaesthesia, 
paraesthesia,  analgesia,  or  hyperalgesia,  as  well  as  affec- 
tion of  muscular  sense  and  kinaesthesis. 

{c)  There  may  be  skin  disturbances,  such  as  arrest 
of  perspiration  or  profuse  perspiration,  especially  under 
the  influence  of  emotions,  worry,  and  fatigue;  such 
perspiration  may  also  occur  at  night,  and  in  some  cases 
the  fear  of  tuberculosis  may  be  associated  with  such 
conditions. 


56       Causation  and   Treatment^  Psychopathic  Diseases 

{d)  The  lungs  may  become  affected  functionally, 
and  there  may  occur  respiratory  disturbances;  coughing, 
hawking,  apnea,  dyspnea,  and  asthmatic  troubles  may 
result, 

(<?)  The  heart  becomes  affected,  bringing  about 
precordial  pain;  palpitation  of  the  heart,  bradycardia, 
tachycardia,  and  cardiac  arrhythmia  may  result. 

(/)  The  stomach  and  intestines  become  affected; 
indigestion,  vague  fugitive  soreness  and  pain  may  be 
experienced  all  over  or  in  special  regions  of  the  ab- 
domen; constipation  or  diarrhea  may  ensue. 

{g)  The  renal  apparatus  may  become  affected  and 
its  activity  arrested,  or,  as  is  more  often  the  case  in  the 
milder  forms  of  psychopathic  troubles,  there  may  be 
present  an  alteration  in  the  amount  or  frequency  of 
micturition,  such  as  is  found  in  the  conditions  of  anuria 
and  polyuria. 

{h)  Menstruation  becomes  disturbed,  and  we  may 
meet  with  conditions  of  dysmenorrhea,  amenorrhea, 
menorrhagia,  and  other  disturbances  of  the  tubes, 
ovaries,  and  uterus. 

{i)  There  are  disturbances  of  the  nervous  system, 
such  as  headache,  and  a  general  dull  sensation  of  fatigue 
and  paresis  of  all  mental  functions,  with  dizziness  and 
vertigo. 

On  the  mental  side  we  find  in  the  psychopathies  the 
following  disturbances : — 

{a)  Affections  of  perceptual  activity, — illusions  and 
hallucinations. 

{b)  Affections  of  intellectual  activity, — argumenta- 
tiveness in  regard  to  insignificant  things,  metaphysical 
and  theological  disputations. 

(c)  Affections  of  the  moral  sense, — scrupulousness, 
overconscientiousness,   not  living  up   to   ideal   states. 

{d)  Affections  of  religious  life, — commission  of  sins 
and  fear  of  punishment. 

{e)     Affections  of  social  life, — timidity,  blushing,  etc. 


Fear  Instinct^  Symptoms  of  Psychopathic  Diseases     57 

(/)  Affections  in  regard  to  objects,  such  as  astro- 
phobia,  acmephobia,  agoraphobia,  claustrophobia,  etc. 

{g)     Affections  of  conceptual   life, — insistent  ideas. 

(A)     Affections  of  the  attention, — aprosexia. 

(i)  Affections  of  the  will, — states  of  aboulia  and 
uncontrollable  impulses. 

(j)  Affections  of  the  memory, — amnesic  and  param- 
nesic  states. 

{k)     General  mental  fatigue. 

(/)  Affections  of  sexual  life, — perversion  and  inver- 
sion. 

(m)     Affections  in  regard  to  marital  relations. 

(w)  Affections  in  regard  to  personal  life, — diffidence, 
self-condemnation,  self-depreciation. 

(0)  Affections  of  apparent  loss  of  personality, — 
feeling  of  self  gone. 

{p)  Formation  of  new  personalities, — dual  and 
multiple  personality. 

In  connection  with  all  such  psychoneurotic  affections 
we  find  invariably  present  a  feeling  of  unrest,  of  un- 
easiness, a  feeling  of  anxiety,  conscious  or  subconscious, 
an  anxious  feeling  of  some  impending  evil.  In  all  such 
affections  we  find  the  brooding  spirit  of  the  most  power- 
ful of  all  animal  instincts, — the  fear  instinct. 

All  those  affections  in  psychopathic  cases  are  mani- 
festations of  fear.  They  are  the  symptoms  of  the  fear 
instinct.  Fear,  with  its  consequent  feeling  of  anxiety 
of  some  impending  evil  is  the  cause  of  all  the  symp- 
toms of  functional  psychosis  in  general  and  of  somo- 
psychosis  in  particular.  Remove  the  fear  and  the 
symptoms  will  disappear. 

The  fear  instinct,  revealed  by  examination  of  psycho- 
genesis  in  the  case  of  somopsychosis,  becomes  still  more 
evident  in  the  case  of  psychoneurosis.  In  psychoneuro- 
sis  the  fear  protrudes  into  the  upper  consciousness. 
The  patient  clearly  indicates  his  fears  in  his  account, 
and  one  has  to  be  misled  with  abstruse  theoretical 


58       Causation  and  Treatment,  Psychopathic  Diseases 

considerations  not  to  notice  clearly  that  the  whole 
matter  is  one  of  the  fear  instinct.  The  patient  lays 
stress  on  his  state  of  fear  by  every  gesture,  attitude, 
speech,  and  by  his  account  of  his  trouble.  He  comes 
to  the  physician  with  some  kind  of  fear  of  something, 
and  finally  shows  fear  in  general,  and  asks  the  physician 
to  assure  him  that  his  mind  is  not  giving  way,  as  he  is 
mortally  afraid  of  insanity.  Some  of  the  psychoneuro- 
tics work  themselves  up  into  such  a  state  of  excitement 
that  they  make  arrangements  with  their  relatives  and 
friends  to  take  care  of  them  and  stand  by  them  when 
their  mind  will  succumb.  The  whole  state  is  one  of 
fear,  of  intense  fear,  of  frenzy  and  panic. 

Functional  psychosis,  both  somopsychosis  and  psy- 
choneurosis,  can  be  reduced  to  one  source, — the  fear 
instinct.  The  anxiety  present  in  the  various  forms 
of  psychopathic  maladies  is  the  pang  of  dissolution, 
the  foreshadowing  of  death-agonies,  the  agonising  fear 
of  dissolution  such  as  is  present  in  cases  of  angina 
pectoris.  In  fact,  the  fear-paroxysm  of  functional 
psychosis  is  even  worse  than  the  death-agony  itself. 
Anxiety  is  conscious  or  subconscious  fear  of  pain  and 
suffering,  vague  as  to  extent  and  intensity.  In  anxiety 
there  is  an  element  of  uncertainty.  Fears  which  have 
their  roots  deep  down  in  the  subconscious  are,  there- 
fore, specially  apt  to  become  feelings  of  anxiety. 
Neither  inattention,  nor  disappointments,  nor  fatigue, 
physical  or  mental,  nor  exhaustion  of  disease,  nor 
suppression  of  wishes  and  desires,  nor  suppressed  and 
unsatisfied  sexual  life,  nor  conflicts,  nor  shocks  of 
themselves,  can  ever  give  rise  to  psychopathic  states. 
It  is  only  in  so  far  as  they  become  associated  with  the 
fear  instinct  that  psychopathic  states  can  arise.  The 
fear  instinct  is  the  sole  cause  of  psychopathic  affections. 

It  may  be  well  to  point  out  here  that  in  neuropsy- 
chosis the  fear  is  conscious,  or,  at  any  rate,  sufficiently 
clear  for  the  physician  to  find  it  out  and  reveal  it  to 


Fear  Instinct,  Symptoms  of  Psychopathic  Diseases     59 

the  patient,  while  in  somopsychosis  the  fear  is  entirely 
submerged  and  subconscious,  the  somatic  symptoms 
alone  constituting  the  patient's  conscious  complaint.  In 
psychoneurosis  the  patient  has  an  inkling  of  fear  in  his 
dread  of  objects,  states  of  mind,  moral  scruples,  lack 
of  confidence,  blushing,  religious  or  social  expectations, 
of  some  coming  misfortune  and  some  mysterious  evil, 
but  he  is  not  aware  of  the  fear  instinct  developed  in 
him  by  the  events  and  training  of  early  childhood. 
The  fears  of  early  childhood  are  all  subconscious.  At 
any  rate,  the  patient  does  not  connect  them  with  his 
present  mental  affection.  In  somopsychosis  the  patient 
is  entirely  innocent  of  the  whole  situation,  he  is  entirely 
engrossed  by  the  somatic  symptoms  which  he  regards 
as  the  sum  and  substance  of  his  trouble,  the  fear  is 
entirely  subconscious. 

The  fear  instinct  fostered  by  frights,  scares,  dread 
of  sickness,  by  religious  instruction  with  its  fear  of  the 
Lord,  moral  and  religious  injunctions,  with  fear  of 
punishment  for  failure  in  the  moral  standard  and 
duties,  the  enforcement  of  social  taboos  with  the 
consequent  dread  of  failure  and  degradation,  all  go  to 
the  cultivation  of  the  fear  instinct  which  in  later  life 
becomes  manifested  as  somopsychosis  or  psychoneu- 
rosis. All  functional  psychosis,  whether  somopsychosis 
or  psychoneurosis,  is  nothing  else  but  an  obsession  of 
the  fear  instinct,  conscious  and  subconscious. 

The  deleterious  influence  of  fear-instinct  on  the 
nervous  system  is  well  stated  by  Dr.  Crile: 

"It  has  been  shown  that  the  various  cases  of  the  dis- 
charge of  nervous  energy  produce  alterations  in  the 
nervous  system  and  probably  in  the  thyroid  gland. 
This  is  especially  true  of  the  fear  stimulus,  and  has 
been  clearly  demonstrated  in  the  brains  of  rabbits 
which  had  been  subjected  to  fear  alone.  Of  special 
interest  was  the  effect  of  daily  fright.  In  this  case 
the  brain-cells  showed  a  distinct  change,  although  the 


6o      Causation  and  Treatment,  Psychopathic  Diseases 

animal  had  been  subjected  to  no  fear  for  twenty-four 
hours  before  it  was  killed.  Now,  a  great  distinction 
between  man  and  the  lower  animals  is  the  greater 
control  man  has  acquired  over  his  actions.  This 
quality  of  control,  having  been  phylogenetically  most 
recently  acquired,  is  the  most  vulnerable  to  various 
nocuous  influences.  The  result  of  a  constant  noci- 
integration  may  be  a  wearing-out  of  the  control  cells  of 
the  brain.  In  a  typical  case  of  Graves'  disease  a  marked 
morphologic  change  in  the  brain-cells  has  been  demon- 
strated. As  has  been  previously  stated,  the  origin 
of  many  cases  of  Graves'  disease  is  associated  with 
some  noci-influence.  If  this  influence  causes  stimula- 
tion of  both  the  brain  and  the  thyroid,  its  excessive 
action  may  cause  impairment  of  the  brain  and  also 
hyperplasia  of  the  thyroid.  As  self-control  is  impaired, 
fear  obtains  an  ascendency,  and,  pari  passu,  stimulates 
the  thyroid  gland  still  more  actively.  Finally,  the 
fear  of  the  disease  itself  becomes  a  noci-stimulus. 
As  the  thyroid  secretion  causes  an  increase  in  the 
facility  with  which  nervous  energy  is  discharged,  a 
pathologic  reciprocal  interaction  is  established  between 
the  brain  and  the  thyroid.  The  effect  of  the  con- 
stantly recurring  stimulus  of  the  noci-influence  is 
heightened  by  summation.  This  reciprocal  goading 
may  continue  until  either  the  brain  or  the  thyroid  is 
destroyed.  If  the  original  noci-stimulus  is  withdrawn 
before  the  fear  of  the  disease  becomes  too  strong,  and 
before  too  much  injury  to  the  brain  and  thyroid  has 
been  inflicted,  a  spontaneous  cure  may  result.  Re- 
covery may  be  greatly  facilitated  by  complete  thera- 
peutic rest.  A  cure  implies  the  return  of  the  brain- 
cells  to  their  normal  state,  with  the  re-establishment  of 
the  normal  self-control  and  the  restoration  of  the 
thyroid  to  its  normal  state,  when  the  impulses  of  daily 
life  will  once  more  have  possession  of  the  final  common 
path  and  the  noci-influence  will  be  dispossessed.     The 


Fear  Instinct,  Symptoms  of  Psychopathic  Diseases    6i 

discovery  of  the  real  cause  of  a  given  case  of  Graves' 
disease  is  frequently  difficult  because  it  may  be  of  a 
painful  personal  nature.  Of  extreme  Interest  is  the 
fact  that,  in  the  acute  stage,  the  patient  may  be  unable 
to  refer  to  the  exciting  cause  without  exhibiting  an 
exacerbation  of  the  symptoms  of  the  disease.  I  pre- 
sume no  case  should  be  regarded  as  cured  until  reference 
can  be  made  to  Its  cause  without  an  abnormal  reaction. 
It  has  been  established  that  In  Graves'  disease  injury 
to  any  part  of  the  body,  even  under  inhalation  anes- 
thesia, causes  an  exacerbation  of  the  disease.  Fear 
alone  may  cause  an  acute  exacerbation.  These  acute 
exacerbations  are  frequently  designated  'hyperthy- 
roidism,' and  are  the  special  hazard  of  operation. 

"In  applying  the  principle  of  anoci-associatlon  In 
operations  on  patients  with  Graves'  disease  there  is 
scarcely  a  change  in  the  pulse,  in  the  respiration,  or  in 
the  nervous  state  at  the  close  of  the  operation.  I  know 
no  remedy  which  can  obviate  the  effect  of  the  inflowing 
stimuli  from  the  wound  after  the  cocain  has  worn  off. 
It  Is  necessary,  therefore,  not  to  venture  too  far  in 
serious  cases.  Since  the  adoption  of  this  new  method 
(anoci-assoclation)  my  operative  results  have  been  so 
vastly  improved  that  now  I  rarely  regard  any  case  of 
Graves'  disease  as  inoperable,  at  least  to  the  extent  of 
contraindicating  a  double  ligation: 

"Average  5  P.  Ai.  pulse-rate  of  ten  patients  during 
the  first  four  days  after  operation: 

Ether  119 

Nitrous  Oxide  112 

AnocI  103 " 

"Thus  we  can  understand  the  variations  in  the  gastric 
analyses  in  a  timid  patient  alarmed  over  his  condition 
and  afraid  of  the  hospital.  He  is  integrated  by  fear  and 
as  fear  takes  precedence  over  all  other  impulses,  no  organ 
functionates  normally.  For  the  same  reason,  one  sees  ani- 
mals in  captivity  pine  away  under  the  dominance  of  fear.'' 


62       Causation  and   Treatment,  Psychopathic  Diseases 

Neurosis  may  be  represented  as  a  fixed  ideosensory 
nucleus,  surrounded  by  a  more  or  less  variable  network 
of  associations  the  stability  of  which  increases  with 
the  recession  from  the  nucleus  to  the  periphery  or 
marginal  fringe  of  consciousness. 

Fear  of  strangeness,  of  unfamiliarity,  developed  in 
early  childhood,  may  remain  unassociated  and  thus  give 
rise  to  a  state  of  vague  fear.  The  instinct,  however, 
may  through  experience,  through  some  trauma,  find 
for  itself  an  object  and  become  associated  with  it. 
"Anxiety,  fear,  horror,"  says  Mosso,  "will  twine  them- 
selves perpetually  around  the  memory,  like  deadly 
ivy  choking  the  light  of  reason. "  It  is  the  fear  instinct, 
the  fundamental  instinct  of  self-preservation,  that  gives 
rise  to  all  forms  of  recurrent  mental  states,  with  all  their 
agony,  anxiety,  despair,  and  depression.  The  fear  in- 
stinct is  at  the  basis  of  psychopathic  diseases.  All  the 
symptoms  in  their  infinite  variety  are  so  many  different 
manifestations  of  the  one  fundamental  fear  instinct. 

The  inner  conflict  and  introspection  characteristic 
of  psychopathic  troubles,  are  pathological,  solely  be- 
cause of  their  association  with  the  fear  instinct.  Men- 
tal conflict  and  introspection  never  give  rise  to  a  mental 
malady;  they  are  rather  favorable  to  a  speculative 
mind.  When,  however,  introspection  and  mental 
conflict  are  associated  with  the  fear  instinct,  the  result 
is  a  psychopathic  malady.  In  the  same  way  a  physical 
sickness  in  itself,  or  the  thought  of  suffering,  physical 
or  mental,  does  not  give  rise  to  a  psychopathic  aiTection. 
It  is  only  when  the  sickness,  or  the  thought  of  disease, 
becomes  associated  with  the  fear  instinct,  only  then 
does  a  psychopathic  malady  arise.  The  source  of 
psychopathic  affections  is  the  fear  instinct,  a  develop- 
ment of  which  in  early  childhood  predisposes  to  all 
forms  of  psychopathic  states. 

Functional  psychosis  or  neurosis  is  an  obsession 
of  the  fear  instinct,  conscious  and  subconscious.     Thus 


Fear  Instinct,  Symptoms  of  Psychopathic  Diseases     63 

one  of  my  patients  became  obsessed  with  fear  of  tuber- 
culosis, manifesting  most  of  the  symptoms  of  "con- 
sumption" after  a  visit  of  a  tuberculous  friend. 
Another  patient  became  possessed  with  the  fear  of 
death  after  visiting  a  sick  relative  of  his  in  one  of  the 
city  hospitals.  Another  became  obsessed  with  the 
fear  of  syphilis  after  having  been  in  contact  with  a 
friend  who  had  been  under  antiluetic  treatment. 
In  all  these  psychopathic  fears  there  was  a  long  history 
of  a  well  developed  subconscious  fear  instinct,  often 
traced  to  experiences  of  early  childhood.  Take  away 
the  fear  and  the  psychosis  or  neurosis  disappears. 

As  we  have  pointed  out,  according  to  the  investi- 
gations of  Pavloff,  Vasiliev,  Babkin,  Savadsky,  Mish- 
tovt,  Orbeli,  Sherrington,  and  others,  ideosensory 
changes  initiated  in  the  central  nervous  system  and 
especially  emotional  disturbances,  bring  about  exten- 
sive motor  and  circulatory  reactions,  accompanied  by 
glandular  secretions.  Recently  Schultze  has  found 
that  glycosuria  accompanies  fear  psychosis,  and  that 
the  amount  of  glycosuria  present  varies  with  the  degree 
and  intensity  of  depression  and  fear,  reaching  its 
highest  amount  with  the  maximum  of  the  fear  psycho- 
sis. The  clinical  studies  of  Raimann,  Arndt,  and  also 
my  own  go  to  confirm  the  same  interrelation.  The 
experiments  of  Cannon,  Shohl,  Wright,  and  de  la  Paz 
carried  out  on  animals  prove  the  intimate  relation  of 
emotion,  and  more  especially  of  fear-anger  emotions, 
and  stimulation  of  adrenal  secretion;  the  increased 
secretion  of  epinephrine  gives  rise  to  glycosuria.  The 
extensive  motor  reactions,  the  circulatory  disturbances, 
and  especially  the  stimulations  of  glandular  secretions 
and  their  consequent  effects  on  the  total  systemic 
reactions  of  the  organism  under  the  influence  of  the 
fear  instinct  form  a  psychophysiological  foundation 
for  the  psychopathology  of  functional  psychosis  or 
neurosis. 


CHAPTER  VII 

THE   MAIN    PRINCIPLES   OF    PSYCHOPATHIC   DISEASES 

I  have  formulated  the  following  fundamental  prin- 
ciples of  psychopathic  diseases : 
I.  The  Principle  of  Embryonic  Psychogenesis. 
Psychopathic  maladies,  like  sarcomatous  and 
carcinomatous  growths,  are  of  an  embryonic  type, 
having  their  genesis  in  the  psychic  stroma  of  early 
childhood.  The  genesis  of  psychopathic  diseases  can 
be  traced  to  a  pathological  germ  focus,  to  a  phobo- 
experience  as  germinal  nucleus  round  which  the  fear 
instinct  becomes  organized.  This  pathological  focus 
keeps  up  the  fermentation,  development,  and  growth 
of  the  slowly  forming  psychopathic  symptom  complex. 
Psychopathic  states  are  primarily  embryonic.  The 
pathogenic  germs  of  the  primitive  fear  instinct  are 
planted  in  the  embryonic  mental  tissues  of  early  child 
life.  The  psychogenesis  of  neurosis  is  an  embryonic 
fear  instinct. 

II.  The  Principle  of  Recurrence^.  In  the  simple  life 
of  the  child,  under  the  influence  of  slowly  changing 
environment,  the  psychopathological  system  of  the 
aroused  fear  instinct,  formed  in  early  childhood,  tends 
to  recur,  both  in  the  waking  and  sleeping  states,  espe- 
cially in  the  intermediate  hypnoidal  states  to  which  the 
child  is  subject,  as  demonstrated  by  my  observations 
and  experiments. 

III.  The  Principle  of  Proliferation  and  Complication. 
With  the  gradual  change  of  the  environment  and  with 

IThe  principle  of  Recurrence  is  fundamental  in  Psychology  and  Psy- 
chopathology.  Recurrence  is  a  foim  of  reproduction  of  various  types  of 
moments.     See  The  Foundations,  Part  II. 

64 


Main  Principles  of  Psychopathic  Diseases         65 

the  growth  of  the  child,  each  recurrence  of  the  fear  sys- 
tem tends  to  an  increased  proliferation  of  fear  associa- 
tions. There  is  a  tendency  to  formation  of  a  complex 
psychopathic  system  which  grows  more  complicated 
with  the  proliferation  of  conscious  and  subconscious 
associations,  and  with  the  ever  increasing  assimilation 
of  new  masses  of  fear  and  anxiety  experiences,  further 
induced  and  kept  up  by  worries  of  a  depressing  and 
unfavorable  environment.  The  pathological  focus  with 
its  organizing  fear  instinct  as  substratum  brings  about 
an  ever  greater  proliferation  and  complication  with  the 
growing  assimilation  of  psychic  contents,  forming 
the    psychopathic    matrix    of  the    symptom    complex. 

IV.  The  Principle  of  Fusion  or  of  Synthesis.  The 
newly  assimilated  psychic  contents,  entering  into  the 
slowly  forming  complex  fear  system,  are  at  first  in  a 
state  of  confused,  incoherent  disaggregation  and 
disorganization.  With  the  repetition  of  the  processes 
of  recurrence,  proliferation,  and  complication,  the 
psychic  contents  become  firmly  associated,  synthesized, 
and  organized  into  an  integral  psychic  compound  with 
the  fear  instinct  as  the  main,  inner,  controlling  focus. 
The  psychic  contents  become  fused,  synthesized  into 
one  complex  network  of  fear  obsessions. 

V.  The  Principle  of  Contrast.  Feelings  and  emotions 
follow  the  law  of  alternation  by  association  of  contrast. 
After  an  intense,  prolonged,  and  exhausting  activity 
of  a  complex  system  with  one  set  of  feelings  and 
reactions,  another  system  with  a  contrasting  set  of 
emotions  and  reactions  is  brought  into  function.  Thus 
excitement  and  passion  of  emotional  pleasure-tone  may 
pass  into  its  opposite  of  contrasting,  disagreeable, 
painful  feeling.  Feelings  of  excitement,  passion,  and 
exhilaration  may  be  followed  by  disgust,  nausea,  and 
even  vomiting.  Such  emotional  alternation  is  by  some 
medical  men  ascribed  to  fanciful,  speculative,  anatom- 


66       Causation  and   Treatment,  Psychopathic  Diseases 

ical  and  embryologlcal  connections.  The  principle  is 
essentially  central  in  nature.  The  particular  form  of 
its  expression  is  a  matter  of  central  associations  formed 
by  experience.  The  fear  instinct  becomes  attached  to 
the  opposed  contrast  emotions  of  self-regard,  such  as 
love  and  desire.  Fear,  though  positive  and  primary, 
assumes  a  negative  and  secondary  aspect  as  non-fulfill- 
ment of  desire  or  fear  of  loss  of  the  object  of  love. 

Psychomotor  reactions  with  contrast  feeling  tone  may 
be  formed  by  means  of  voluntary  association  for  the 
relief  or  rather  for  the  inhibition  of  too  great  tension 
of  unpleasant  overexcitement.  The  law  of  contrast 
is  characteristic  of  the  mental  life  of  primitive  man  and 
of  the  undeveloped  consciousness  of  the  child,  as  well 
as  of  the  degenerative,  atavistic  states  of  psychopathic 
diseases.  Psychopathic  fear  compounds  with  feelings 
of  depression  alternate  with  systems,  having  as  their 
feeling-tone  states  of  mental  exhilaration.  This  con- 
dition gives  rise  to  that  mental  alternation  so  typical 
of  psychopathic  diseases,  closely  simulating  manic- 
depressive  psychoses. 

VI.  The  Principle  of  Recession.  Child  experiences 
tend  to  lapse  from  conscious  memory.  This  tendency 
is  further  reinforced  by  the  process  of  recession,  de- 
veloped in  detail  in  my  works.  Cognitive  states  recede 
from  the  focus  to  the  periphery  of  consciousness,  but 
emotional  fear  reactions  to  particular,  conditional  stimuli 
keep  on  recurring  reflexly,  automatically.  The  reced- 
ing mental  states  become  marginal  and  subconscious. 
Such  states,  to  use  a  Mendelian  term,  are  recessive. 
Recessive  states  recede  and  fade  away  from  conscious- 
ness with  each  recurrence  or  reproduction  of  the  symp- 
tom complex. 

VII.  The  Principle  of  Dissociation.  Recessive  ele- 
ments and  states,  becoming  marginal  and  submerged 
subconsciously,  lapse  from  voluntary  control  and  from 


Main  Principles  of  Psychopathic  Diseases        6y 

recall  of  conscious  memory;  they  fall  outside  the 
dominant  conscious  life  of  the  individual.  The  lapsed 
states  are  present  subconsciously,  and  can  be  repro- 
duced in  various  subconscious  conditions,  such  as 
hypnotic,  hypnoid,  hypnoidal,  and  hypnoidic,  a  de- 
scription of  which  I  give  in  The  Symptomatology. 
Recessive  elements  and  states  fall  outside  the  domain 
of  voluntary  associations,  and  as  such,  they  are  regarded 
as  dissociated  from  the  patient's  personal  life  activity. 
Dissociated  systems  become  parasitic,  and,  like  malig- 
nant growths,  suck  the  life  energy  of  the  affected 
individual.  Under  unfavorable  conditions  and  appro- 
priate stimulations  these  dissociated,  parasitic,  recessive 
systems  become  manifested  in  later  life,  giving  rise  to 
fully  developed  symptom  complexes  of  psychopathic 
states. 

VIII.  The  Principle  of  Irradiation  or  of  Diffusion. 
The  various  factors  of  recurrence,  complication,  fusion, 
contrast,  recession,  and  dissociation  tend  to  neutraliza- 
tion of  various  characters  of  life  experiences,  entering 
into  synthesis  of  the  pathological  complex  system. 
The  fear  emotion  becomes  devoid  of  much,  if  not  of 
all,  of  the  cognitive  content  of  experience.  During 
this  stage  of  the  growth  of  the  psychopathic  symptom 
complex  the  affected  individual  may  for  a  time  appear 
normal.  The  pathological  condition,  however,  is  sub- 
consciously dormant.  Meanwhile,  the  fear  instinct, 
acting  like  a  fermenting  enzyme,  keeps  on  affecting 
more  and  more  psychic  material.  Like  a  malignant 
tumor,  growing  by  infiltration,  the  latent,  subconscious 
fear  instinct  becomes  gradually  infiltrated,  diffused, 
irradiated  throughout  the  psychic  life  of  the  individual, 
finally  giving  rise  to  a  general  diffused  state  of  apprehen- 
sion, anxiety,  and  anguish. 

IX.  The  Principle  of  Differentiation.  With  the 
growth  of  the  child's  personal  life  and  with  the  further 


68       Causation  and  Treatment^  Psychopathic  Diseases 

development  of  cognitive  activity  the  general  diffused 
emotion  of  the  fear  instinct  with  its  feeling  of  anxiety 
and  anguish,  either  through  a  series  of  traumas  or 
through  the  intensity  of  a  shock,  becomes  associated 
with  some  special  object  or  event  in  the  patient's 
present  life  experience,  forming  the  apparent  nucleus 
of  the  neurosis,  constituting  the  ultimate  fear  state.  This 
apparently  central  nucleus  could  not  possibly  of  itself 
evoke  all  the  extensity  and  intensity  of  the  fear  reac- 
tions of  the  psychopathic  states,  were  it  not  for  the 
great  mass  of  fear  systems  which  lend  the  last  trauma 
its  overwhelming  force.  The  last  trauma,  however, 
is  but  the  exciting  cause,  simply  revealing  the  latent 
psychosis  or  neurosis  which  becomes  differentiated 
along  definite  lines  of  mental  life. 

X.  The  Principle  of  Dominance.  Ultimate  fear  states 
persist  in  consciousness,  becoming  amplified  and  inten- 
sified with  the  unfolding  of  mental  life.  Such  mental 
states,  normal  and  abnormal,  to  use  another  Mendelian 
term,  are  dominant.  In  many  cases,  under  unfavor- 
able conditions  of  life  and  education,  the  fear  experi- 
ences of  early  childhood  become  reinforced  by  a  series 
of  further  traumas,  which  help  the  formation  and 
keep  up  the  recurrence  of  ultimate  fear  states.  The 
fear  instinct,  like  a  malignant  growth,  expands  along 
lines  of  least  resistance.  The  dominant  systems 
persist  throughout  the  vicissitudes  of  life,  giving  rise 
to  a  fully  developed  somatopsychosis  or  psychoneurosis. 

XL  The  Principle  of  Dynamogenesis.  This  factor 
is  important  in  the  domain  of  psychopathology  and 
psychotherapy.  It  is  intimately  related  to  the  more 
general  and  more  fundamental  principle  of  reserve 
energy,  developed  independently  by  Professor  James 
and  by  myself.  A  dissociated  system  of  recessive 
elements,  latent  and  inactive,  gathers  force,  manifesting 
itself  in  subconscious  eruptions,  convulsing  the  patient's 


Main  Principles  of  Psychopathic  Diseases        69 

general  life  activity.  Subconscious  systems  of  recessive 
states,  when  called  into  function,  respond  to  appropriate 
stimulations  with  intense  psychomotor  reactions.  The 
mass  of  associated  systems  exercises  control  on  each  one 
of  its  constituent  systems.  When  a  system  is  disso- 
ciated, the  control  is  removed, — it  is  like  a  mechanism 
without  its  controlling,  governing  gear,  manifesting  all 
its  latent  energy,  giving  rise  to  increased  dynamogenesis. 
The  emotion  of  the  fear  instinct  becomes  abnormally 
intense  and  uncontrollable. 

XII.  The  Principle  of  Inhibition.  According  to  the 
principle  of  irradiation  and  fusion,  the  fear  instinct 
tends  to  spread  and  gets  diffused  throughout  the  pa- 
tient's personality.  The  fear  instinct  keeps  on  os- 
cillating, spreading,  changing  with  age,  education, 
sex,  and  fluctuations  of  personal  interests,  spreading 
to  states  farther  and  farther  removed  from  the  original 
pathological  focus  with  which,  however,  the  states 
remain  firmly  associated.  The  neurosis  may  thus  pass 
through  many  stages  of  metamorphosis  with  new 
determinations,  but  the  fear  nucleus  remains  ever  the 
same,  gathering  more  and  more  energy  with  each  trans- 
forming interest.  When  the  fear  instinct  becomes 
intense  and  diffused,  it  begins  to  exercise  an  inhibitive 
influence  on  nervous  and  mental  functions.  This 
inhibition  by  the  hypertrophied  fear  instinct  is  specially 
strong  on  all  those  functions  and  systems  that  enter 
into  the  synthesis  of  the  psychopathic  aggregate. 

XIII.  The  Principle  of  Diminishing  Resistance.  In 
proportion  as  the  psychopathic  condition  with  its 
symptom  complex  keeps  on  recurring,  the  pathological 
system  formed,  is  gaining  not  only  in  energy,  but  also 
in  ease  of  manifestation.  The  psychopathic  state  is 
evoked  at  the  least  occasion.  The  psychopathological 
symptom  complex  emerges  at  an  ever  diminishing 
intensity  of  stimulation.     The  influence,  the  control, 


70       Causation  and   Treatmentj  Psychopathic  Diseases 

the  resistance  of  associative  systems,  constituting  the 
individuality  of  the  patient,  is  more  and  more  weakened. 
The  resistance  of  healthy,  normal  associations  is  ever 
diminishing,  until  a  point  is  reached  when  all  power 
of  opposition  and  control  is  lost.  The  psychopatho- 
logical  system  with  its  symptom  complex  gets  complete 
sway  over  the  patient's  life,  and  becomes  an  uncon- 
trollable, psychopathic  obsession. 

XIV.  The  Principle  of  Metathesis  and  Control  by 
Mcdification.  In  the  psychognosis  of  psychopathic  cases 
I  find  that  in  controlling  the  attack  the  patient  may 
have  recourse  to  a  procedure  which  m.ay  help  him  in  the 
inhibition  of  the  psychopathic  symptom  aggregate. 
The  patient  is  unable  to  control  his  psychopathic  state 
by  means  of  reasoning  or  exhortation,  but  he  awakens 
another  morbid  state  with  accompanying  symptoms 
of  a  psychopathic  character.  This  awakened  psy- 
chopathic state  changes  the  trend  of  mental  life 
with  its  psychomotor  reactions.  The  old  psycho- 
pathic state  no  longer  occupies  the  mental  field, — it 
must  give  room  to  another  set  of  associations  which 
may  temporarily  supplant  the  old  psychopathic  aggre- 
gate. The  patient  deliberately  and  voluntarily  brings 
about  various  psychomotor  conditions  which  help 
him  to  weaken  the  grip  of  the  insistent  psycho- 
pathic state.  This  is  accomplished  by  stimulating  a 
set  of  sensori-motor  processes,  accompanied  by  morbid 
emotional  fear  and  anxiety  states.  If  the  patient 
worries  about  certain  physical  or  mental  symptoms 
from  which  he  suffers,  he  calls  forth  some  other  symp- 
toms of  disease  about  which  he  will  worry,  or  he  may 
induce  other  sensori-motor  reactions  with  similar 
feeling  tone.  The  same  result  may  be  accomplished  by 
voluntarily  inducing  ideo-motor  states,  fear  of  evil 
omens,  signs,  tests,  and  magic  charms,  bound  up  with 
similar  feeling  tone,    mental    states    of    the    same    or 


Main  Principles  of  Psychopathic  Diseases         71 

similar  emotional  and  feeling  quality.  New  fear  states 
are  thus  formed  which  temporarily  may  inhibit  or  at 
least  modify,  for  the  time  being,  the  old,  recurrent, 
psychopathic  state.  If  the  original  state  be  indicated 
by  P,  the  awakened  sensori-motor  or  ideational 
processes  by  S  and  I  respectively,  their  accompany- 
ing psychopathic  state  by  Pi,  the  resulting  mental 
conditions  by  P2,  then  we  may  represent  the  total 
process,  sensory  or  ideational,  by  the  following  form- 
ulae:   P+S+Pi=P2    (i),  and  P+I+Pi=P2     (2) 

The  principle  of  metathesis  or  of  modification  is  im- 
portant in  the  determination  of  the  course  of  develop- 
ment taken  by  the  psychopathic  aggregate.  This  con- 
tinuous modification  which  the  patient  is  forced 
to  take  to  free  himself  from  the  grip  of  the 
pathological  mental  state  keeps  on  extending,  enlarging, 
and  changing  the  pathological  aggregate  in  various 
directions  on  ever  new  lines,  giving  new  fear  deter- 
minations to  the  psychopathic  manifestations.  The 
symptoms  keep  on  changing,  although  the  funda- 
mental state  with  its  initial  experiences  remains  as  the 
central,  controlling  nucleus  which  can  only  be  dis- 
covered by  a  careful  psychognosis. 

This  progressive  series  of  fear  determinations  of 
the  original  psychopathic  state  makes  it  impossible 
for  the  patient  himself  to  understand  the  original 
experience,  and  to  grasp  the  primitive  trend  of  the 
psychopathic  nucleus  in  the  gradual  progressive  course 
of  its  formation  to  the  time  of  the  acme  of  its 
development.  A  comprehension  can  only  be  fully 
attained  by  a  thorough  psychognosis  of  the  case,  and 
by  the  tracing  of  the  psychopathic  state  or  aggregate  to 
Its  primordial  nucleus.  The  physician  can  thus  realize 
the  history  of  the  formation  of  the  ultimate  fear  states 
constituting  the  present  psychopathic  system  complex. 
The  revelation  of  the  primitive,  psychopathic  nucleus 


72       Causation  and   Treatment,  Psychopathic  Diseases 

unravels  the  complex  skein  of  mental  states,  and  makes 
it  possible  to  differentiate  the  important  from  the 
unimportant,  the  essential  from  the  inessential.  This 
procedure  is  valuable  from  a  psychotherapeutic  stand- 
point, inasmuch  as  the  finding  of  the  nucleus  makes 
possible  its  disintegration  which  in  its  turn  helps  the 
disorganization  of   the   psychopathic   aggregate. 

This  principle  of  metathesis  or  of  modification  may 
be  regarded  as  a  factor  in  the  integration  and  disintegra- 
tion of  the  psychopathic  aggregate.  The  afferent,  eff- 
erent; and  central  processes  of  the  aggregate  are  modifi- 
able^. The  modifiability,  however,  is  not  the  same  for 
all  the  processes.  The  motor  elements  are  the  easiest  to 
change,  the  sensory,  and  the  glandular  reactions  with 
the  afferent  elements  they  give  rise  to  are  more  difficult 
to  modify,  while  the  central,  affective,  emotional  syn- 
thesis, being  the  total  product,  is  the  last  to  be  affected. 
This  law  of  modifiability  is  of  consequence  in  Psy- 
chotherapy. We  shall  take  up  the  discussion  of 
this  subject  further  on  in  this  work. 

The  evolution  of  psychopathic  systems  follows  along 
these  principles.  A  close  psychognosis  of  psychopathic 
cases  reveals  the  paramount  importance  of  these 
psychopathological  principles  in  the  life  history  of  the 
psychopathic  aggregate  from  its  germinal  stage  to  its 
fully  developed  state  of  organization.  Each  case,  when 
closely  investigated,  clearly  reveals  these  fundamental, 
psychopathological  principles. 

IThe  development  of  the  psychopathic  system  on  the  principle  of  meta- 
thesis follows  the  evolution  of  the  compound  synthetic  moment.  See  The 
Foundations,  Part  II. 


CHAPTER  VIII 

THE   LAW   OF   RECESSION 

THE  hierarchy  of  moments  from  the  lowest 
to  the  highest,  belonging  to  one  organized 
constellation  of  moments,  may  be  arranged 
in  a  series  as  to  intensity  and  vividness  of 
consciousness,  ranging  from  minimum  to  maximum 
through  all  degrees  of  intensity  and  vividness.  The 
maximum  of  intensity  is  in  the  focus  or  in  the  nucleus 
of  the  moment,  the  minimum  is  at  the  periphery. 
A  moment,  through  frequent  functioning,  gradually 
loses  intensity  and  vividness,  and  passes  by  degrees 
through  the  intermediary  stages  from  maximum  to 
minimum.  The  fading  moment  passes  by  degrees 
from  the  centre  to  the  periphery  of  consciousness. 

If,  however,  the  intensity  and  vividness  of  psychosis 
decrease  from  the  center  to  the  periphery,  the  extent  of 
content  increases.  The  further  away  from  the  centre 
the  greater  is  the  number  of  the  fading  moments, 
and  at  the  periphery  the  number  of  moments  is 
also  the  greatest.  The  immense  number  of  outlived 
moments  gradually  fade  away  with  greater  duration, 
and  tends  to  pass  to  the  periphery  of  consciousness. 
It  is  clear  then  that  as  we  pass  from  the  centre  to  the 
periphery  the  number  of  outlived  moments  increases 
proportionately.  The  deeper  the  regions  of  the  sub- 
conscious the  wider  the  extent  of  its  contents.  In 
hypnosis  the  intensity  of  consciousness  becomes  diffused 
over  lower  and  lower  moments,  liberating  their  pent-up 
energy,  and  as  with  the  depth  of  hypnosis  the  obscure 
regions  of  the  subconscious  are  lightened  up,  their 
immense  extents  stand  revealed  before  the  astonished 

73 


74       Causation  and   Treatment^  Psychopathic  Diseases 

and  bewildered  eye  of  the  observing  self-consciousness. 

A  lighting  up  of  the  subconscious  regions  can  also 
be  brought  about  hy  the  use  of  opium  or  hashish.  The 
pent-up  neuron-energy  becomes  liberated  from  lower 
and  lowermost  moment,  psychosis  becomes  concomi- 
tantly manifested  and  long  forgotten  experiences  tend 
once  more  to  the  centre  of  consciousness,  outlived 
moments  become  resurrected  and  rise  to  the  surface 
of  full  consciousness  with  all  the  vividness  of  a  present 
reality.  Thus  De  Quincey  in  his  ^^Confessions  of  an 
English  opium-eater^^  tells  us  that  "the  minutest 
incidents  of  childhood  or  forgotten  scenes  of  later 
years  were  often  revived.  I  could  not  be  said  to 
recollect  them,  for  if  I  had  been  told  of  them  when 
waking,  I  should  not  have  been  able  to  acknowledge 
them  as  my  past  experience.  But  placed  as  they  were 
before  me  in  dreams  like  intuitions  and  clothed  in  all 
their  evanescent  circumstances,  and  accompanying 
feelings,  I  recognized  them  instantaneously."  Hypnoi- 
dic  states,  such  as  described  by  me  in  my  previous 
works,  also  reveal  the  wealth  and  extent  of  psychic 
content  present  in  the  lower  subconscious  regions. 
Glimpses  into  the  subconscious  are  also  given  in  hypnoi- 
dal  states  which  are  induced  by  the  process  of  hyp- 
noidization. 

A  moment,  in  passing  from  the  centre  of  consciousness 
to  the  lower  regions  of  the  subconscious,  is  effecting 
its  course  gradually  through  all  degrees  of  intensity, 
ranging  from  maximum  to  minimum.  In  learning  to 
play  a  violin,  for  instance,  the  movements  of  adjust- 
ments are  at  first  effected  with  much  strain  and  inten- 
sity of  attention,  but  a  long  course  of  exercise,  practice 
and  repetitions  slowly  reduce  the  strain  and  intensity 
of  attention  until  the  act  of  playing  and  the  necessary 
motor  adjustments  for  it  require  the  minimum  of  con- 
sciousness   and    minimal    amount   of   strain,    in   other 


The  Law  of  Recession  75 

words,  the  act  becomes  habitual,  automatic.  A  habit 
is  not  formed  suddenly.  A  series  of  repetitions  is 
requisite,  each  repetition  making  the  next  one  easier 
and  reducing  the  strain  and  intensity  of  consciousness, 
until  the  minimum  is  reached. 

Of  course,  the  minimum  is  relative  for  the  particular 
moment-consciousness.  Some  of  them  have  a  higher 
and  some  a  lower  minimum,  although  none  of  them 
may  pass  the  absolute  minimum.  This  largely  depends 
on  the  complexity  of  the  moment.  The  more  complex 
the  moment  is  the  higher  the  minimum,  although  they 
all  have  a  tendency  to  reach  ultimately  the  absolute 
limit.  In  other  words,  a  more  complex  moment  or 
aggregate  of  moments  takes  a  longer  time  and  a  larger 
series  of  repetitions  to  reach  the  absolute  minimum  of 
consciousness.  A  simplification  in  the  constitution  of 
the  moment  makes  the  process  of  reduction  more  rapid, 
but  the  moment  on  its  way  to  the  minimum  has  never- 
theless to  pass  through  the  different  degrees  of  intensity. 
The  course  of  this  process  is  the  one  characteristic  of 
the  accumulative  moment  on  its  way  to  the  simple 
form  of  reproduction,  belonging  to  the  type  of  the 
desultory  moment-consciousness.*  The  passing  through 
intermediate  stages  is  a  necessary  condition  of  reduction 
of  a  functioning  moment  to  a  minimum  of  consciousness. 
In  other  words,  the  law  of  recession  is  the  process  of 
a  moment's  passing  from  the  conscious  into  the  sub- 
conscious, often  effected  by  intermediate    gradations. 

*See  The  Foundation,  Part  II,  Multiple  Personality,  The  Psychology 
of  Suggestion. 


CHAPTER  IX 

THE    LAW    OF    REVERSION 

IN  the  reverse  process,  in  the  process  of  a  moment's 
rise  from  the  subconscious  to  the  conscious,  inter- 
mediary stages  are  not  always  requisite.  The 
moment,  buried  in  the  obscure  regions  of  the 
subconscious,  may  be  Hghtened  up  with  intense  focal 
light  of  consciousness  without  passing  through  any 
intermediary  stages.  The  direct  or  fading  process  is 
the  dying  away  of  light,  the  reverse  process  is  the 
blazing  up  of  a  torch  or  the  explosion  of  gun-powder. 
When  we  come  to  discuss  the  physiological  aspect  of 
the  two  processes,  we  shall  see  that  there  is  a  good 
reason  for  this  difference.  Meanwhile  we  confine 
ourselves  to  the  statement  of  this  difference  between 
the  manifestations  of  the  two  processes  from  a  purely 
psychological  standpoint. 

That  intermediary  stages  of  consciousness-intensity 
are  not  necessary  and  often  dropped  in  the  reverse 
process,  or  in  the  process  of  the  moment's  rising  from 
the  subconscious  to  the  conscious,  we  may  clearly  see 
from  such  a  commonplace  example  as  the  forgetting  of 
a  once  familiar  name.  We  look  and  search  for  the 
name,  we  try  all  manner  of  clues,  we  strain  our  atten- 
tion in  the  search  after  the  lost  link,  but  of  no  avail. 
In  fact,  the  more  we  try  the  more  we  feel  barred 
from  the  place  where  that  lost  link  is  to  be  found;  we 
feel  lost  and  wandering,  and  finally  give  up  the  whole 
affair  in  great  despair  and  turn  to  something  else.  In 
the  middle  of  our  work  when  we  have  fully  forgotten 
all  about  the  search  of  the  forgotten  word,  the  name 
shoots  up.  No  intermediary  stage  is  passed,  the  whole 
state  flares  up  at  once. 

76 


The  Law  of  Reversion  77 

The  solution  of  difficult  and  complicated  problems,  of 
discoveries  and  inventions  are  known  to  occur  in  this 
way.  Similarly  in  the  phenomena  of  the  various  forms 
of  sensory  and  motor  automatisms  the  sensory  images 
or  the  motor  reactions,  expressive  of  the  rising  psychic 
state,  gush  up  suddenly  from  the  depth  of  the  subcon- 
scious self.  They  come  complete,  like  Minerva  out  of 
Jove's  head. 

In  hypnosis  again,  ideas  and  sensory  motor  reactions, 
induced  by  suggestion  in  hypnotic  states  to  occur 
post-hypnotically  or  in  the  so-called  hypnonergic  state, 
may  flash  suddenly  upon  the  mind  of  the  subject. 
While  in  trance  the  subject  may  be  told  a  word  or  a 
phrase  and  suggested  that  he  should  be  unable  to 
remember  it  on  awakening,  but  that  when  he  hears  the 
word  "now"  coming  from  the  experimenter,  he  should 
be  able  to  remember.  On  emerging  from  the  trance 
state  the  subject  cannot  voluntarily  remember  that 
word  or  phrase,  although  it  may  just  be,  as  some 
say,  on  the  tip  of  his  tongue;  he  may  be  in  a  condition 
similar  to  the  one  when  searching  after  a  familiar  word, 
but  which  somehow  constantly  eludes  his  mental  grasp. 
Generally  though,  if  the  subject  falls  into  deep  hyp- 
nosis, his  amnesia  is  complete  and  he  cannot  remember 
anything  about  the  word,  just  as  if  it  has  been  erased 
from  his  memory.  No  sooner,  however,  does  the  signal 
"now"  reach  him  than  the  forgotten  word  or  phrase 
immediately    and    instantly    flashes    upon    his    mind. 

This  sudden,  "impulsive"  rise  of  moments  from  the 
subconscious  into  the  light  of  central  consciousness 
can  be  even  more  clearly  seen,  more  concretely  realized, 
so  to  say,  in  the  post  hypnotic  suggestion  of  the  motor 
character.  During  hypnosis  the  subject  is  suggested 
to  do  a  certain  act  on  perceiving  a  certain  signal,  but 
that  he  should  not  have  the  least  memory  of  what  he  is 
going  to  do  before  the  signal  is  given.     On  coming  out 


78       Causation  and   Treatment,  Psychopathic  Diseases 

of  the  hypnotic  trance,  if  this  be  deep,  he  remembers 
nothing  and  may  engage  in  something  else;  no  sooner 
does  he  perceive  the  signal  than  he  jumps  up  and 
carries  out  the  suggested  act  with  great  impetuosity  and 
Hghtning-Hke  rapidity.  The  suggested  psychomotor 
reaction,  hidden  subconsciously,  appears  in  the  light 
of  consciousness  as  instantly  as  the  discharge  of  the 
gun  at  the  release  of  the  trigger,  or  as  the  ring  of  the 
electric  bell  at  the  touch  of  the  button. 

If  we  turn  to  psychopathic  cases,  we  once  more  meet 
with  evidence  of  the  same  truth,  we  find  instances  the 
very  essence  of  which  consists  in  the  fact  that  inter- 
mediary stages  of  the  moment's  transition  from  the 
subconscious  to  the  conscious  are  completely  wanting. 
The  sudden  onset  of  uncontrollable  impulses  and 
imperative  ideas  is  notorious.  Patients  who  have 
been  quiet  and  listless  for  many  months  and  even 
years  rise  suddenly,  fell  their  attendant  with  one 
powerful  blow,  and  Immediately  after  return  to  their 
previous,  listless  state.  The  outburst  is  instantaneous. 
Suicidal  and  homicidal  Impulses,  accompanying  various 
forms  of  mental  alienations,  may  have  a  sudden  onset, 
and  vanish  as  abruptly  as  they  come. 

Imperative  ideas  may  also  have  the  same  flash-like 
appearance.  The  idea  enters  the  mind  suddenly,  tor- 
ments the  patient  by  its  insistency  and  then  somehow 
unaccountably  vanishes.  These  impulses  and  ideas  are 
like  meteors,  they  appear  lightning-like  on  the  mind's 
horizon,  and  then  drop  out  of  sight.  Thus  all  the  ad- 
duced facts  now  verge  to  one  truth  that  reverse 
procession  of  a  moment  from  the  subconscious  region 
to  the  light  of  consciousness  need  not  be  through 
intermediary  stages. 

It  may  also  be  pointed  out  that  the  same  lack  of 
intermediary  stages  holds  true  of  the  moment's  retro- 
grade movement  when  falling  back  into  the  regions 


The  Law   of  Reversion  79 

whence  it  has  appeared  into  the  focus  of  the  upper 
consciousness.  In  fact,  we  may  say  that  this  fit-like 
process  is  often  even  more  characteristic  of  the  return- 
ing of  the  moment  into  the  subconscious  than  of  its 
coming.  We  all  have  experienced  the  fact  how  some 
ideas,  whether  familiar  or  not,  often  flash  across  the 
mind  and  the  next  moment  disappear  as  mysteriously 
and  as  tracelessly  as  they  come;  they  drop  into  the  sub- 
conscious before  the  upper  consciousness  can  seize  on 
them,  fixate  them,  and  have  them  assimilated.  Hyp- 
noidal  states  are  of  such  a  nature;  they  are  sudden 
upheavals  from  the  depth  of  the  subconscious,  they 
often  disappear  from  consciousness  as  suddenly  as 
they  appear.  The  same  we  find  in  the  case  of 
uncontrollable  impulses,  they  invade  consciousness, 
and  get  possession  of  it,  like  an  attack,  and  then  seem- 
ingly drop  out  of  sight,  sometimes  not  even  as  much  as 
a  trace  or  a  vague  memory  is  left. 

In  the  states  of  hypnosis  such  coming  and  going  of 
subconscious  moments  can  be  investigated  more 
closely.  During  hypnosis  a  story  may  be  told  to  the 
subject,  and  then  a  suggestion  given  that  on  awakening 
at  the  giving  of  a  signal,  at  the  hearing  of  a  sound,  the 
story  should  occur  to  the  subject's  mind,  but  not 
before,  and  that  the  subject  should  relate  it,  but  that 
as  soon  as  he  finishes,  the  whole  thing  should  immedi- 
ately lapse  from  his  consciousness.  If  the  subject  takes 
post-hypnotic  suggestion,  and  is  capable  of  that  stage 
of  hypnosis  where  amnesia  can  be  induced,  then  the 
rise  and  fall  of  subconscious  moments  are  almost 
instantaneous,  palpably  demonstrating  the  truth  that 
the  subconscious  moment  does  not  necessarily  require 
to  pass  transitional  stages  in  consciousness,  whether 
forwards  or  backwards,  whether  it  enters  from  the 
ubconscious  to  the  focus  of  consciousness  or  leaves 
he  focus  to  be  sunk  into  the  subconscious. 


8o       Causation  and   Treatment,  Psychopathic  Diseases 

This  law  of  reversion  with  its  want  of  intermediary 
stages  in  the  history  of  the  rise  and  fall  of  the  subcon- 
scious moment  is  not  uniform.  The  subconscious  mo- 
ment may  rise  slowly,  pass  in  a  general,  rough  form 
intermediary  stages  of  intensity  of  consciousness,  enter 
the  focus,  and  may  again  in  departing  fade  away  slowly, 
by  degrees,  passing  through  all  grades  of  consciousness- 
intensity  in  its  backward  course.  This  is  especially 
frequent  in  cases  when  the  given  moment  rises  spon- 
taneously from  a  great  depth  of  the  subconscious. 
The  moment  seems  to  struggle  on  Its  way  with  many 
obstacles,  hence  its  oscillations,  its  many  failures  in  its 
rise  to  full  intensity. 

The  same  thing  occurs  in  the  different  forms  of  sen- 
sory and  motor  automatisms,  also  in  states  of  halluci- 
nations and  in  some  hallucinations  found  in  the  dream 
consciousness.  The  reversion  of  the  moment  Is  accom- 
panied by  increased  sensory  intensity,  assimilating  on 
its  way  in  the  reverse  direction  from  the  subconscious 
to  the  focus  of  consciousness  as  many  experiences  as 
possible  with  their  primary  and  secondary  sensory  ele- 
ments.* The  sensory  intensity  gains  in  proportion  as 
the  vividness  and  clearness  of  abstract  associations  di- 
minish In  activity.  The  moment,  buried  In  the  depth  of 
the  subconsciousness,  does  not  stand  out  clear  and  dis- 
tinct, but  often  struggles  up  In  an  aborted  form  as  a 
series  of  failures,  blunders,  and  errors. 

This  reversion  of  the  moment  from  the  subconscious, 
this  rise  of  the  hidden  moment  to  the  focus  of  conscious- 
ness, and  the  subsequent  recession  into  the  subcon- 
sciousness, with  the  increase  of  sensory  intensity  as 
the  moment  forces  Its  way  in  the  reverse  direction 
from  the  subconscious  to  the  conscious  may  be  termed 
the  law  of  moment  reversion,  while  the  two  movements, 
the  reversion  and  the  recession,  constitute  the  cyclical 
movement  of  the  moment  consciousness. 

*See  Multiple  Personality,  The  Foundations,   Symptomatology. 


CHAPTER  X 

THE    PROCESS    OF    DEGENERATION 

EACH  Stimulation  leaves  after  it  some  mo- 
ment-disaggregation,  a  condition  that  makes 
further  disaggregation  more  difficult.  The 
more  intense  the  stimulation  is,  the  more  ex- 
tensive and  deeper  is  the  disaggregation,  and  hence 
the  more  difficult  further  disaggregation  becomes.  If 
the  stimulation  is  continued  or  made  highly  intense,  a 
point  is  soon  reached  beyond  which  no  stimulation  can 
pass  without  giving  rise  to  disaggregation,  having  as 
its  manifestation  the  different  forms  of  pathological 
mental  dissociation.  The  pathological  process,  under- 
lying the  phenomena  of  abnormal  mental  life,  is  not 
essentially  different  from  the  one  taking  place  in  normal 
states.  If  difference  there  be,  it  is  not  certainly  one  of 
a  quality,  but  of  degree. 

The  more  intense  a  stimulation  is,  the  more  extensive 
is  the  process  of  disaggregation,  the  higher  mounts  the 
moment-threshold,  giving  rise  to  the  different  phenom- 
enon of  psycho-physiological  and  psychomotor  dis- 
sociation. As  expressed  in  a  former  work:  "The 
process  of  disaggregation,  setting  in  under  the  action 
of  strong  and  hurtful  stimuli,  is  not  something  new  and 
different  in  kind  from  the  usual;  it  is  a  continuation 
of  the  process  of  association  and  dissociation  normally 
going  on  within  the  function  and  structure  of  higher 
constellations.  The  one  process  gradually  passes  in- 
to the  other  with  the  intensity  of  duration  of  the 
stimulus." 

The  process  of  disaggregation  is  a  descending  one, 
it  proceeds  from  constellations  to  groups.     Under  the 

8i 


82       Causation  and  Treatment^  Psychopathic  Diseases 

influence  of  strong  stimulation,  such  as  mechanical  and 
chemical  agencies,  and  psychic  affections,  such  as 
intense  emotions  of  fear,  and  their  derivatives,  the 
degenerative  process  of  disaggregation  sets  in,  af- 
fecting first  the  higher  aggregates,  and  then  with  the 
continuity  and  intensity  of  the  stimulations  the  process 
descends  deeper  and  deeper,  affecting  less  complex  ag- 
gregates, finally  reaching  the  simplest  aggregates  of 
moments.  The  higher  types  of  moments  degenerate 
and  fall  to  lower  and  lower  stages  of  consciousness. 

The  law  of  moment  disaggregation  as  that  of  degene- 
ration is  from  the  complex  to  the  simple.  The  lower 
moments,  on  account  of  the  simplicity  of  their  organ- 
ization, are  more  stable  than  the  more  complex  and 
higher  moment,  and  are  in  a  better  condition  to  resist 
the  disaggregating  action  of  hurtful  stimulations. 

Furthermore,  the  lower  and  simpler  an  aggregate  of 
moments  is,  the  older  it  is,  either  phylogenetically  or  on- 
togenetically,  and  therefore,  its  stability  is  more  firmly 
assured  by  selection  and  adaptation.  In  the  course  of 
the  life-existence  of  the  individual  and  the  species  lower 
types  of  moments  have  come  more  often  into  activity, 
since  the  higher  an  aggregate  is,  the  later  does  it  rise  in 
the  history  of  evolution.  Hence  moments  that  are  not 
working  smoothly,  are  continually  weeded  out. 

This  same  process  is  going  on  not  only  in  the  history 
of  the  species  by  the  eliminating  action  of  natural 
selection,  but  also  by  the  special  adaptations  brought 
about  in  the  life  experience  of  the  individual.  In  phylo- 
genesis the  best  and  most  firmly  organized  instincts  sur- 
vive, while  in  ontogenesis  those  habits  are  consciously 
or  unconsciously  selected  which  are  most  firmly  estab- 
lished and  are  best  adapted  to  the  given  end.  At  the 
same  time  the  older  a  reaction  is,  the  more  thoroughly 
organized  it  becomes,  the  more  is  it  enabled  to  with- 
stand the  onslaught  of  external  hurtful  stimuli.     The 


The  Process  of  Degeneration  83 

same  holds  true  in  the  case  of  habits.  A  habit  of  long 
standing  is  well  organized,  and  it  is  often  extremely 
difficult,  if  not  impossible,  to  control. 

Food  reactions,  sex  reactions,  social  reactions,  and  per- 
sonal moral  life  form  an  ascending  series  both  as  to 
time  of  appearance  in  the  history  of  the  species  as  well  as 
complexity  of  structure  and  function.  Food  instincts 
in  time  and  simplicity  precede  sex  instincts,  and  sex 
instincts  in  their  turn  precede  social  instincts  which 
antecede  personal,  moral  life.  Now  we  find  that  the 
instability  is  in  the  same  ascending  line.  Food  reactions 
are  more  stable  than  sex  reactions,  sex  reactions  are  more 
stable  than  social  reactions  which  are  more  firmly  organ- 
ized than  a  highly  unified  personal  life,  guided  by  a 
moral  ideal.  The  structure  and  functions  of  the 
system  of  alimentation  remain  unchanged  for  ages; 
the  sex  reactions  may  become  slightly  modified  for  some 
period  of  time;  the  functions  relating  to  social  life 
vary  from  generation  to  generation,  while  moral  life, 
guided  by  moral  ideal  is  highly  individualized  and 
personal. 

In  the  downward  course  of  mental  disease-processes 
the  degeneration  is  from  the  complex  to  the  simple, 
from  the  stable  to  the  instable,  from  the  highly  organ- 
ized to  the  lowly  organized.  In  the  different  forms  of 
mental  diseases  first  moral  life,  then  social  reactions 
are  affected,  the  patient  loses  all  regard  for  others, 
becomes  careless,  wasteful  and  negligent  of  his  voca- 
tions, life-work,  and  duties. 

In  certain  forms  of  mental  alienation,  such  as  mel- 
ancholia and  paranoia,  the  patient  becomes  suspicious 
of  others,  of  his  near  and  dear  ones,  becomes  cruel  and 
revengeful,  sometimes  ending  by  attacking  his  own 
friends  and  near  relatives  by  committing  homicide. 
When  the  deterioration  of  personal  moral  life  and  social 
reactions    is    well  under  way,     degeneration  of  other 


84      Causation  and  Treatment,  Psychopathic  Disease 

functions  sets  in, — the  patient  gives  himself  over  to 
excesses,  to  all  kinds  of  debauches,  and  indulges  in  the 
different  forms  of  abnormal  sexual  practices.  Only- 
very  late  in  the  course  of  the  disease  are  the  food  re- 
actions in  any  way  affected. 

The  phenomena  manifested  under  the  action  of  nar- 
cosis go  further  to  confirm  the  same  point  of  view. 
Moral,  personal  life  is  the  first  to  succumb,  other  activi- 
ties follow  in  the  order  of  their  complexity  and  duration 
of  function.  In  other  words,  the  law  of  disaggregation 
or  that  of  degeneration  is  from  the  complex  to  the  sim- 
ple, from  the  highly  organized  to  the  lowly  organized, 
from  the  least  stable  to  the  most  stable.  This  stability 
is  proportionate  to  the  complexity  of  moment  aggre- 
gates, and  to  the  frequency  and  duration  of  their  asso- 
ciative activity. 

In  habits,  formed  within  the  life  time  of  the  indi- 
vidual, the  same  law  holds  true.  Old  habits  are  in- 
veterate, habits  formed  in  childhood  and  perpetuated 
can  hardly  be  eradicated,  while  those  that  are  formed 
later  in  life  become  more  easily  dissolved.  Complex 
habits,  formed  in  late  life,  relating  to  moral  life  and 
social  intercourse,  become  dissolved  at  the  first  onset 
of  the  process  of  mental  degeneration,  while  habits 
formed  early  in  life,  such  as  handling  spoons,  fork,  and 
plate  or  dressing  and  buttoning  the  coat  long  resist 
the  degenerative  process.  Paretics  and  patients  of 
secondary  dementia,  though  far  advanced  on  the  down- 
ward path  of  degeneration,  are  still  for  some  time  able 
to  attend  to  the  simpler  functions  of  life,  such  as  dress- 
ing and  feeding.  Once  more  we  are  confronted  with 
facts  pointing  to  the  same  law  that  the  process  of  degen- 
eration of  which  disaggregation  constitutes  a  stage  is 
from  the  highly  to  the  lowly  organized,  from  the  com- 
plex to  the  simple,  from  the  rational  to  the  automatic. 


The  Process  of  Degeneration  85 

Even  in  the  lighter  forms  of  psychic  degenerative 
forms  that  lie  on  the  borderland  of  mental  alienation, 
such,  for  instance,  as  are  present  in  the  various  forms 
of  psychopathic  maladies  we  still  find  that  the  same 
relation  holds  good.  Moral,  personal,  rational  life  is  the 
first  to  be  affected.  Social  activities  follow,  while  dis- 
turbances of  sex  and  food  reactions  set  in  late  in  the 
course  of  the  pathological  process  of  disaggregation  and 
degeneration. 

In  psychopathic  cases  of  advanced  standing  the 
process  of  degeneration  brings  about  a  simplification 
of  life.  The  complicated  systems  of  mental  and  moral 
life  are  dissociated,  disaggregated,  and  disorganized. 
Like  in  a  flood,  the  rich  soil  deposits  are  swept  away 
and  the  primitive  bed  rock  is  left  exposed  to  view,  in 
the  case  of  psychopathic  patients  all  higher  structures 
and  functions  are  temporarily  suspended,  the  most 
primitive  impulses  and  instincts,  serving  the  preserva- 
tion and  protection  of  the  individual,  remain, — the 
impulse  of  self-preservation  with  its  accompanying 
instinct  of  the  fear  instinct  reigns  supreme.  Fear 
rooted  in  the  primitive  impulse  of  self-preservation 
forms  the  pathology  of  psychopathic  diseases. 


CHAPTER  XI 

THE    IMPULSE    OF    SELF-PRESERVATION    IN    PSYCHO- 
PATHIC  DISEASES 

A  S  we  have  pointed  out  the  fear  instinct  is 
/  \  the  arousal  of  the  impulse  of  self-preserva- 
X  .\.  tion.  Psychopathic  conditions  are  at 
bottom  fear  states  which  in  turn  are  based 
on  the  abnormal,  pathological  conditions  of  self- 
preservation.  This  is  manifested  in  the  fundamental 
trait  of  extreme  selfishness  characteristic  of  all  psycho- 
pathic patients.  The  patient  is  entirely  absorbed  in 
himself  and  is  ready  to  sacrifice  every  one  to  his  de- 
mands and  cravings. 

For  many  years,  day  after  day  and  night  after  night, 
I  lived  with  patients  who  were  under  my  care, 
observation,  and  treatment.  One  trait  always  revealed 
to  me  the  predominant  characteristic  under  the  con- 
stantly changing  psychopathic  symptom-complex  and 
that  is  the  extreme  selfishness  of  the  patients.  There 
is  no  greater  egotism  to  be  found  than  in  the  typical 
cases  of  psychopathic  affections.  This  egotism  runs 
parallel  to  the  condition  of  the  psychopathic  state. 
This  does  not  mean  then  that  every  egotist  is  necessa- 
rily psychopathic,  but  every  psychopathic  case  is  essen- 
tially egotistic.  The  psychopathic  patient  does  not 
hesitate  a  moment  to  sacrifice  to  his  "affection"  father, 
mother,  brother,  sister,  husband,  wife,  lover,  friend, 
and  children.  In  severe  cases  the  patient  stops  at 
nothing,  and  only  fear  of  suffering,  sickness,  evil 
consequences,  and  punishments  can  alone  restrain  the 
patient.  In  some  extreme  cases  the  patient  is  occa- 
sionally almost  diabolical  in  his  selfishness. 

86 


The  Impulse  of  Self-Preservation  87 

The  constant  sympathy  which  the  patients  crave 
from  others  and  which  they  demand,  if  it  is  not  given 
to  them  immediately,  is  but  an  expression  of  their 
extreme  obsession  by  the  impulse  of  self-preservation. 
In  their  struggle  for  self-preservation  they  forget  every- 
thing else,  nothing  is  remembered  but  themselves. 
This  condition  becomes  the  ground  character  which  is 
often  expressed  in  a  frank,  brutal  way.  Even  in  the 
best  of  patients  one  can  find  glimpses  into  the  depths 
of  the  psychopathic  soul  which  is  nothing  but  the 
immense  egotism  of  the  beast,  worsted  in  the  struggle 
for  existence,  tortured  by  the  agonizing  pangs  of  the 
fear  instinct. 

In  the  vanity,  conceit,  arrogance,  and  overbearing 
attitude  towards  others,  friend  or  stranger,  as  well  as 
in  the  total  indifference  to  the  suffering  of  his  inti- 
mate friends  and  acquaintances  we  once  more  find  the 
expression  of  that  infinite  selfishness  which  obsesses 
the  psychopathic  patient.  In  order  to  get  rid  of  some 
slight  inconvenience,  or  to  obtain  some  slight  pleasure 
the  patient  will  put  others  as  well  as  his  "near  and 
dear  ones"  not  only  to  inconvenience,  but  to  permanent 
pain,  and  even  torture.  The  patient  lacks  confidence, 
at  least  that  is  what  he  complains  of,  but  he  does  not 
hesitate  to  demand  of  his  best  friends  and  even  of 
total  strangers  all  the  services  possible,  if  they  are  given 
to  him,  thinking  that  he  is  fully  entitled  to  them. 
The  patient  has  the  conceit  and  vanity  of  his  great 
worth  in  comparison  with  other  people.  The  world 
and  especially  his  family,  friends  and  lovers,  should 
offer  their  happiness  and  life  for  his  comfort. 

Even  when  the  psychopathic  patient  does  some 
altruistic  act,  it  is  only  in  so  far  as  he  himself  can 
benefit  by  that  deed.  He  is  ready  to  drop  it  as  soon 
as  the  work   does   not   answer    his    selfish    purposes. 


88       Causation  and   Treatment,  Psychopathic  Diseases 

Himself  first  and  last,  that  is  the  essence  of  psycho- 
pathic life. 

The  patient  is  convinced  of  his  goodness  and  kindness 
and  of  his  human  affections  which  are  far  superior  to 
those  of  the  common  run.  He  adores  himself,  and  he 
is  always  ready  to  dwell  in  the  glory  of  his  delicacy 
and  extraordinary  sensitivity.  This  trait  he  is  specially 
anxious  to  impress  on  his  friends,  on  his  family, 
and  even  on  those  whom  he  apparently  loves. 
"I  am  the  delicate  being  of  whom  you  all,  unap- 
preciative,  gross,  insensible  people,  should  take  care. " 
That  is  the  principle  on  which  the  psychopathic  patient 
lives.  The  patient  will  do  anything  to  attract  atten- 
tion to  this  side  of  his  personality.  He  will  emphasize 
his  sickness,  exaggerate  his  symptoms  and  even  manu- 
facture them  for  the  benefit  of  those  who  dare  to  ignore 
him  or  who  pay  little  attention  to  his  condition,  to  his 
wants,  needs,  caprices,  and  passing  whims.  There  is 
nothing  so  tyrannical  and  merciless  as  the  autocratic 
"weak"  will  of  a  psychopathic  patient  once  he  gains 
ascendancy. 

The  patient's  whole  attention  is  concentrated  on 
himself,  or  more  specially  on  the  symptoms  of  his 
psychopathic  malady,  symptoms  which  obsess  him  for 
the  time  being.  Whatever  the  symptoms  be,  perma- 
nent or  changing,  the  patient's  demand  is  to  have 
others  sympathize  with  his  illness  from  which  he  suf- 
fers, to  have  them  realize  the  fearful  agonies  which  he 
undergoes.  The  selfishness  of  the  patient  is  exacting 
and  knows  no  bounds.  The  whole  world  is  to  serve 
him,  and  be  at  his  command.  The  psychopathic  pa- 
tient is  driven  by  the  impulse  of  self-preservation  and 
by  the  furies  of  the  fear  instinct. 

Many  of  my  psychopathic  patients  tell  me  that  they 
feel  sensitive  as  long  as  they  witness  the  sufferings  of 
other  people,  otherwise  they  do  not  care  to  know  any- 


The  Impulse  of  Self-Preservation  89 

thing  about  them.  They  are  anxious  to  have  such 
things  away  from  them  as  a  nuisance.  They  insist  on 
being  surrounded  only  with  pleasant  things  or  with  per- 
sons and  objects  that  contribute  to  their  health. 
Everything  is  absorbed  by  the  worship  of  the  Moloch 
Health  to  whom  the  patients  sacrifice  everything. 
Pain,  suffering,  and  distress  of  other  people  are  looked 
at  only  from  the  standpoint  of  the  possible  effect  they 
may  have  on  the  patient's  precious  health.  Like  Nero, 
who  was  probably  of  a  psychopathic  character,  the  psy- 
chopathic patient  is  ready  to  burn  others  for  his  health; 
if  necessary,  to  torture  health  out  of  others. 

One  of  my  patients,  who  is  very  intelligent,  tells  me 
frankly  that  he  uses  others  to  squeeze  out  of  them 
strength  for  himself.  As  soon  as  he  can  no  longer  get 
it,  or  has  obtained  all  he  could,  he  is  anxioys  to  part 
with  them,  gets  tired  of  them,  and  even  begins  to  be 
resentful,  because  they  are  in  the  way  of  his  health. 
Another  of  my  patients  was  ready  to  burn  parks,  sta- 
bles, and  destroy  everything,  if  he  knew  that  it  was 
good  for  his  health.  Other  patients  of  mine  do  not 
hesitate  to  wake  up  the  whole  house  of  people  to  help 
themselves  in  insomnia  or  indigestion.  Many  of  my 
patients  take  pleasure  in  forming  acquaintance  and 
even  friendship  with  people,  ask  for  their  sympathy, 
require  their  help  and  assistance,  come  to  them  early 
in  the  morning  and  late  at  night,  disturb  their  sleep 
in  the  small  hours  of  the  morning,  display  all  the  symp- 
toms of  indigestion,  nausea,  eructation,  and  vomiting. 
Then  the  patients  turn  round,  abuse  the  person  who 
helps  them,  telling  him  disagreeable  things,  because  he 
is  no  longer  useful.  A  few  hours  later  the  patients 
may  turn  again  for  help  to  the  same  person,  because 
they  find  that  they  could  still  make  use  of  him. 

Psychopathic  patients  do  not  hesitate,  for  the  allevi- 
ation of  their  pains,   of  depression,   of   insomnia,    to 


90      Causation  and  Treatment,  Psychopathic  Diseases 

take  a  bath  in  the  early  morning  and  wake  up  all  the 
other  patients.  The  others  will  not  hesitate  to  do  the 
same.  They  are  entirely  absorbed  in  themselves.  Self 
is  the  only  object  of  their  regard.  A  patient,  a  clever 
lawyer,  aptly  characterised  one  of  my  most  severe  and 
most  typical  psychopathic  cases  as  "egomaniac." 
"When  you  talk  of  gravity,  'I  am  gravity'  she  claims. 
Talk  of  the  Trinity:  'I  am  the  Trinity.'  "  As  a  matter 
of  fact,  every  psychopathic  patient  is  an  egomaniac. 
Bacon's  aphorisms  about  self-lovers  may  well  apply  to 
psychopathic  patients : 

"And  certainly  it  is  the  nature  of  extreme  self-lovers, 
as  they  will  set  an  house  on  fire,  and  it  were  but  to  roast 
their  eggs 

"That  which  is  specially  to  be  noted  is,  that  those 
which  are  sui  amantes  sine  rivali,  are  many  times 
unfortunate. " 

Driven  by  the  impulse  of  self-preservation  and  by 
the  anguish  of  extreme  fear,  the  psychopathic  patient 
may  be  pitied  as  a  most  unfortunate,  miserable  wretch. 

In  the  psychognosis  of  the  particular  condition, 
mental  or  nervous,  be  it  object,  idea,  or  action 
from  which  the  patients  suffer,  the  instinct  of  self- 
preservation  with  its  instinctive  emotion  of  fear  can 
always  be  found  in  the  background  of  conscious- 
ness or  in  the  subconsciousness.  An  insight  into 
a  series  of  cases  will  help  best  to  understand  the 
fundamental,  psychopathological  processes  that  give 
rise  to  the  different  forms  of  psychoneuroses  and 
somatopsychoses. 

The  inhibition  of  the  patient's  activities,  with  the 
exception  of  the  most  primitive  impulses  of  self-pres- 
ervation with  its  instinct  of  fear,  limits  the  patient's 
life  to  such  an  extent  that  the  interests  and  the  activi- 
ties are  reduced  to  automatic  repetition  of  reactions 
to  stimuli  of  a  stereotyped  character.     The  stimuli 


The  Impulse  of  Self -Preservation  91 

must  be  the  same  otherwise  the  patient  does  not  care 
to  respond.  He  loses  interest  in  his  business,  in  reading, 
in  his  work,  and  games.  The  attention  keeps  on  wan- 
dering. Games,  pleasures,  and  hobbies  in  which  he 
formerly  used  to  take  an  interest  lose  all  their  attraction 
for  him.  The  life  he  is  disposed  to  lead  is  of  a  vegeta- 
tive existence.  He  is  afraid  of  anything  new.  The 
things  are  done  in  an  automatic  way.  Routine  and 
automatisms  are  characteristic  of  his  activities.  At 
first  the  patient  tries  to  shake  the  slumber  of  his  life, 
but  afterwards  he  gives  in  and  submits  to  the  mo- 
notony which  still  further  emphasizes  the  pathological 
process. 

This  routine  life  is  a  reaction  by  his  organic,  biological 
processes  against  the  onset  of  the  pathological  processes. 
Meanwhile  the  family,  or  friends,  and  even  physicians, 
noticing  this  tendency  in  the  patient,  advise  him  to 
occupy  himself,  to  forget  his  troubles,  to  get  pleasures, 
to  see  some  interesting  things,  and  thus  become  dis- 
tracted. This  is  often  effected  by  taking  the  patient 
away  from  his  environment  and  making  him  travel 
in  foreign  countries.  While  distraction  of  attention 
may  be  of  use  in  some  cases  where  there  is  brooding, 
due  to  some  misfortune,  it  is  certainly  of  little  use  and 
even  harmful  in  many  psychopathic  cases. 

Before  proceeding  with  the  other  factors  we  may 
bring  a  few  cases,  showing  the  factor  of  self-preserva- 
tion with  the  fear  instinct  as  its  manifestation. 

As  a  little  girl  Mrs.  R's  health  seemed  well.  She 
was  active  in  out-of-door  games  which  she  enjoyed. 
She  was  only  a  middling  student. 

R.  received  little  training  of  any  sort  from  her  moth- 
er, and  was  regarded  by  the  neighbors  as  a  "pert" 
child.  She  was  never  given  household  tasks  to  do  and 
she  always  disliked  housework.  As  a  child,  if  she  was 
refused  anything  she  wanted,  she  would  cry  and  scream 


92       Causation  and  Treatment,  Psychopathic  Diseases 

and  kick  till  it  was  given  her,  and  even  up  to  i8  years 
of  age  would  throw  herself  about  on  the  floor,  screaming 
when  she  thought  herself  misused. 

For  the  last  twenty  years  she  has  regarded  herself 
as  an  invaHd.  She  complains  of  headaches,  backaches, 
pains  in  the  chest  and  abdomen,  "indigestion,"  lack 
of  appetite,  and  many  other  ailments.  Not  all  of  these 
complaints  all  the  time,  but  never  free  from  some  of 
them. 

She  is  fond  of  company,  likes  to  gossip,  to  play 
bridge,  and  to  dance, — provided  always  that  her 
husband  or  mother  is  present.  Her  comments  on  her 
neighbors  are  usually  very  harsh,  and,  while  much  in- 
terested in  them,  she  has  little  sympathy.  The  sum- 
mer vacations  are  spent  at  a  camp;  she  enjoys  fishing 
and  motoring  there,  but  is  never  free  from  her  aches 
or  her  fears. 

She  is  always  eager  to  talk  about  her  ailments.  She 
will  cry  and  moan  and  say  she  wants  to  get  well,  and 
fears  she  will  "do  something  rash."  She  says  she 
thinks  she  might  "do  away  with  herself,"  if  she  should 
find  herself  alone  in  the  house.  She  fears  she  may 
go  insane. 

She  has  no  real  interests  in  life.  When  she  wakes  in 
the  morning,  she  wonders  how  she  is  going  to  get 
through  the  day — how  kill  the  time. 

Besides  these  various  complaints  and  fears  she  is 
full  of  other  phobias,  the  result  of  child  fears.  She 
fears  to  be  left  alone  in  the  house  or  to  go  out  alone 
on  the  street.  For  fifteen  years  she  has  not  gone  alone 
from  her  home  to  the  business  street  of  the  village, — 
always  her  husband  or  her  mother  must  be  with  her. 
Either  her  husband  or  her  mother  is  with  her  every 
hour  of  the  twenty-four,  not  in  the  same  room  neces- 
sarily, but  in  the  house.  She  will  not  walk  on  the 
street  with  a  group  of  people  whom  she  has  known  all 


The  Impulse  oj  Self -Preservation  93 

her  life  unless  her  husband  or  mother  be  of  the  party. 
She  will  drive  her  husband's  automobile,  a  big  touring 
car,  and  enjoy  doing  so,  but  her  husband  or  mother 
must  be  in  the  car.  She  also  has  great  fear  of  crowds; 
even  with  her  husband  she  insists  on  sitting  in  the  rear 
pew  at  church.  If  the  rear  pew  is  occupied  she  will  go 
home,  though  there  may  be  plenty  of  vacant  seats  fur- 
ther front.  She  is  terribly  afraid  of  disease,  germs,  and 
contagion, — she  is  always  very  anxious  and  in  a  panic 
on  this  matter  of  disease. 

Mr.  B.,  age  28.  Patient  worked  hard;  timid,  lack 
of  will,  of  persistence. 

A  couple  of  years  ago,  after  death  of  grandfather, 
had  fear  of  death,  lasted  for  five  months.  Two  years 
later,  relations  with  girl,  abortion,  fear  of  being  prose- 
cuted, of  being  accused  of  the  crime.  Has  also  other 
fears  and  anxieties,  such  as  of  money,  also  of  signing  his 
name  wrongly,  or  other  illegal  acts,  fear  that  he  may  be- 
come insane,  inefficient,  incapable.  Suspects  people  of 
knowing  him  or  of  knowing  the  girl,  and  possibly 
reporting  to  the  police.  Cries,  intense  fear  and  anxiety. 
Knows  that  the  object  of  fear  is  unreal;  the  emotion 
is  too  strong  for  him,  it  has  become  associated  with 
everything  he  does  or  reads.  Fears  come  over  him, 
over  reminiscences  from  childhood,  lest  he  has  done 
something  bad  or  evil.  Psychoanalytic  physicians  have 
especially  helped  in  cultivating  those  harmless  memo- 
ries of  childhood,  and  have  associated  them  with  the 
central  instinct  of  fear  and  anxiety.  The  patient 
is  extremely  self-centred,  thinks  only  of  himself,  in- 
ordinately selfish.     Obsessed  with  self  and  fear. 

Mr.  F.,  age  32,  graduate  of  Cornell.  Masturbated 
when  young;  read  literature  on  the  subject  and  began 
to  worry  and  fear  about  the  consequences,  began  to 
dream,  had  sexual  dreams  which  frightened  him  more; 
worried  more,  read  more,  and  dreamt  more.     Entered 


94      Causation  and  Treatment^  Psychopathic  Diseases 

college  (Cornell),  and  felt  miserable,  obsessed  with 
fear  of  mental  ruin.  Laid  up  with  sprained  knee  for 
a  few  weeks  (age  21);  became  constipated;  physician 
spoke  about  auto-intoxication.  Feels  bad;  physician 
ascribed  to  bowels,  then  began  the  fear  consequences. 
(Psychosomatic.)  Feels  depression  and  headache 
(thinks  due  to  auto-intoxication.)  Had  some  head- 
aches in  school  (probably  thinks  he  had.)  When  a 
child  he  was  very  timid,  sensitive,  and  shrinking, 
diffident,  "painful  to  talk  to  him."  Had  a  dread  and 
terror  of  his  parents,  who  were  severe  with  him,  used 
to  beat  him  mercilessly.  Had  strict  religious  train- 
ing, was  very  conscientious  about  religion.  Always 
worried  about  his  health;  is  extremely  selfish. 

Obsessed  by  the  impulse  of  self-preservation  and  fear- 
instinct,  and  with  utter  disregard  of  others,  the  patients 
are  convinced  of  their  extraordinary  kindness,  gentle- 
ness, sympathy,  martyrdom,  and  even  saintliness.  It 
is  from  this  class  that  all  the  neurotic  philanthropists 
are  recruited.  Psychopathic  patients  are  always  ready 
to  sacrifice  themselves  for  the  good  of  humanity,  they 
talk  endlessly  about  goodness,  and  may  even  devote 
themselves  to  charity  work  and  instruction  for  the 
"poor  and  degraded."  A  patient  of  mine  worked  for 
three  years  for  the  good  of  the  poor,  had  "high  ideals 
and  a  sensitive  conscience,"  according  to  his  accounts, 
but  abandoned  readily  his  wife  and  children.  Another 
patient,  a  young  woman,  a  typical  psychopathic,  full 
of  high  ideals,  ran  away  with  a  married  man,  had  a 
child  that  died  by  exposure.  This  patient  was  inter- 
ested in  modern  education  and  improvement  of 
humanity.  She  never  cared  to  do  anything  for  any- 
body, and  without  any  hesitation  took  advantage  of 
others  in  order  to  satisfy  the  least  whim  that  might 
have  crossed  her  mind,  especially  those  whims  that 
relate  to  health.     She  had  all  kinds  of  directions,  pre- 


The  Impulse  of  Self-Preservation  95 

scrlptions,  exercises,  requisite  for  the  strength  and 
health  of  the  body  and  the  nerves. 

One  of  my  patients  was  afraid  when  I  happened  to 
go  away;  he  used  to  be  anxious  about  my  going  and 
my  coming.  Was  it  love  or  devotion?  I  found  out 
that  he  was  afraid  that  I  might  be  killed.  This  fear 
was  developed  in  him  by  an  actual  accident  in  which 
his  brother  had  died,  but  the  same  fear  associated  with 
me  was  due  to  the  fact  that  the  patient  was  sure  that 
my  treatment  was  requisite  for  his  health  and  welfare. 
He  was  in  fear  lest  I  might  be  killed,  he  would  be  una- 
ble to  get  his  treatments,  and  thus  lose  time  in  getting 
back  his  health. 

For  the  sake  of  his  "health"  the  patient  will  not  stop 
at  anything  short  of  murder,  and  even  that  will  only 
be  on  account  of  the  evil  consequences  to  his  health. 
There  is  no  wonder  that  the  "Christian  Science"  neu- 
rotic has  well  named  her  trouble  "Health  and  Science." 
This  is  essentially  psychopathic.  The  psychopathic 
makes  of  health  his  science  and  religion. 

The  psychopathic  patient  may  be  regarded  as  a 
case  of  parasitism.  The  parasite,  living  on  his  host, 
gradually  loses  all  active  functions,  a  condition  fol- 
lowed by  atrophy  of  organs  no  longer  necessary  to  the 
life  existence  of  the  organism.  According  to  Demoor, 
"Atrophy  begins  with  function  when  an  organ  has 
become  useless.  This  uselessness  may  arise  from  two 
causes;  the  function  may  be  no  longer  useful  to  the 
individual  or  to  the  species,  or  it  may  be  assumed  by 
another  organ."  When  an  organism  turns  parasite, 
it  is  an  economy  of  nutrition  and  energy  to  save  as 
much  as  possible.  The  tendency  of  parasitism  is  to 
dispense  with  unnecessary  functions  in  the  struggle  for 
existence.  The  loss  of  function  and  atrophy  Is  from 
the  less  useful,  to  the  more  useful,  to  the  functions  abso- 
lutely indispensable  to  survival;  from  the  less  essential, 


96       Causation  and   Treatment,  Psychopathic  Diseases 

to  the  more  essential,  to  functions  absolutely  essential 
to  the  life  existence  of  the  individual.  The  life  activity 
of  the  parasite  becomes  more  and  more  narrowed, 
circumscribed,  and  dwindles  down  to  a  few  functions 
requisite  to  its  life  existence,  namely  self-preservation, 
nutrition,  and  reproduction.  With  the  further  increase 
of  parasitism  even  the  digestive  and  reproductive  func- 
tions become  simplified,  the  parasitic  individual  be- 
comes reduced  to  the  most  fundamental  of  all  impulses, 
the  impulse  of  self-preservation. 

The  penalty  of  parasitic  life  is  the  simplification  of 
organic  activities,  the  atrophy  of  all  higher  and  com- 
plex life  processes.  This  is  what  takes  place  in  the 
case  of  the  psychopathic  individual.  All  higher  activi- 
ties, all  higher  interests  cease;  in  many  cases  even  the 
sexual  instinct  becomes  gradually  atrophied,  the  patient's 
life  is  being  narrowed  down  to  the  impulse  which  is  abso- 
lutely requisite  for  life  existence,  namely  the  impulse  of 
self-preservation  with  its  concomitant  fear  instinct. 

The  growth  of  the  impulse  of  self-preservation 
with  its  fear  instinct  brings  about  their  hypertrophy 
which  in  turn  hastens  the  degenerative  process  of 
atrophy  of  all  higher  and  more  complex  activities.  The 
psychopathic  patient  in  the  process  of  degeneration 
and  atrophy  falls  so  low  that  not  only  moral,  social, 
and  intellectual,  as  well  as  other  psychomotor  processes 
become  gradually  diminished  and  atrophied,  but  in 
many  cases  even  the  instinct  of  reproduction,  requisite 
for  the  preservation  of  the  species,  is  made  subservient 
to  the  impulse  of  self-preservation  and  the  fear  instinct. 
In  psychopathic  life  all  activities  are  narrowed  down  to 
the  pettiness  of  individual  existence.  All  psychopathic 
interests  are  reduced  to  the  sorry  life  of  self  and  fear. 

Lacking  interest  in  anything  but  himself,  terrorized 
by  the  fear  of  existence,  the  psychopathic  patient  lives 
a  dreary,  monotonous  life  out  of  which  he  seeks  to 


The  Impulse  of  Self-Preservation  97 

escape.  Monotony,  ennuiy  indifference  form  the  curse 
of  his  Hfe.  The  patient  is  in  a  frantic  condition, 
constantly  in  quest  of  interests  which  he  cannot  enjoy. 
Nothing  can  interest  him,  because  he  has  no  other 
interest  but  himself,  and  that  is  so  narrow,  that  it 
can  hardly  fill  existence.  As  a  matter  of  fact  he  is 
afraid  to  meet  his  fears,  he  is  afraid  of  himself.  He  is 
bored  with  himself,  bored  with  everything  and  with 
everybody.  He  is  constantly  eager  to  find  new  pastures 
and  new  excitements,  so  as  to  fill  with  some  living  in- 
terest his  poor,  narrow,  mean,  short  existence  full  of 
fear,  misery,  wretchedness,  and  brutish  selfishness. 
The  patient  is  afraid  of  work,  because  it  may  "fatigue 
and  exhaust"  him,  and  may  bring  about  a  state  of 
disease,  while  he  looks  for  health.  He  has  no  interest, 
because  he  thinks  only  of  his  little  self,  reduced  to 
digestion,  evacuation,  and  sleeping.  The  psychopathic 
patient  leads  an  inactive  existence  of  a  sluggard,  a 
lazy,  idle  existence  of  a  parasite,  and  still  he  is  driven 
to  life  and  activity  which,  from  the  very  nature  of  his 
narrow,  parasitic  individuality,  he  can  no  longer  enjoy. 
He  has  the  ideals  of  a  hero  and  lives  the  life  of  a  coward. 
Obsessed  with  the  anxious  fears  of  the  self-impulse 
he  avoids  the  terrors  of  life,  and  drags  the  grey,  mon- 
otonous existence  of  a  worm.  Hence  there  is  a  tendency 
in  the  psychopathic  patient  to  be  on  the  lookout  for  ever 
new  energetic  personalities,  lean  on  them,  suck  out  all 
the  energies  he  possibly  can,  then  reject  his  new  friends 
unhesitatingly  and  brutally,  and  be  again  in  search  for 
new  personalities  who  can  disperse,  for  ever  so  brief  a 
time,  the  fearful  monotony  and  dread  of  his  miserable, 
psychopathic  existence.  That  is  why  the  patient  may 
be  characterized  as  a  psychopathic  leech,  or  truer  still 
psychopathic  vampire.  For  it  is  on  the  life  and  blood 
of  other  people  that  the  psychopathic  ogre  is  enabled 


98       Causation  and  Treatment,  Psychopathic  Diseases 

to  carry  on  his  bewitched,  accursed,  narrow,  selfish  ex- 
istance,  full  of  terror  and  anguish  of  life. 

The  following  account  by  Schopenhauer  describes 
well  the  psychopathic  Individual : 

"The  aim  of  his  life  is  to  procure  what  will  contribute 
to  his  bodily  welfare,  and  he  is  indeed  in  a  happy  way, 
if  this  causes  him  no  trouble.  If  however  the  luxuries 
of  life  are  heaped  upon  him,  he  will  inevitably  be  bored, 
and  against  It  he  has  a  great  many  fancied  remedies, — 
balls,  theatres,  parties,  cards,  gambling,  horses,  women, 
drinking,  travelling,  and  so  on  (had  Schopenhauer 
lived  in  contemporary  America  he  might  have  added 
New  Thought,  Christian  Science,  and  other  cheerful 
religious  metaphysics  and  psychoanalytic,  Freudian 
twaddle);  all  of  which  cannot  protect  one  from  being 

bored" "Nothing  really  Interests  them  but 

themselves.  They  always  think  of  their  own  case  as 
soon  as  ever  any  remark  is  made,  and  their  whole  atten- 
tion is  engrossed  and  absorbed  by  the  merest  chance  ref- 
erence to  anything  which  affects  them  personally,  be  It 
never  so  remote;  with  the  result  that  they  have  no  pow- 
er left  for  forming  an  objective  view  of  things  should  the 
conversation  take  that  turn;  neither  can  they  admit  any 
validity  In  arguments  which  tell  against  their  Interests 

or  their  vanity They  are  so  readily  offended, 

insulted,  or  annoyed  that  in  discussing  any  Impersonal 
matter  with  them,  no  care  Is  too  great  to  avoid  letting 
your  remarks  bear  the  slightest  possible  reference  to 
the  very  worthy  and  sensitive  Individuals  whom  you 
have  before  you,  for  anything  you  may  say  will  perhaps 
hurt  their  feelings.  True  and  striking  observations, 
fine,  subtle,  and  witty  things  are  lost  upon  them;  they 
cannot  understand  them.  But  anything  that  disturbs 
their  petty  vanity  in  the  most  remote  and  indirect  way, 
or  reflects  prejudicially  upon  their  exceedingly  precious 
selves, — to  that  they  are  most  tenderly  sensitive.     In 


The  Impulse  of  Self-Preservation  99 

this  respect  they  are  like  the  little  dog  whose  toes  you 
are  so  apt  to  tread  upon  inadvertently — you  know  it 
by  the  shrill  bark  it  sets  up;  or  again  they  resemble 
a  sick  man  covered  with  sores  and  boils,  with  whom 
the  greatest  care  must  be  taken  to  avoid  unnecessary 
handling.  And  in  some  this  feeling  reaches  such  a 
pass  that,  if  they  are  talking  with  any  one,  and  he 
exhibits,  or  does  not  sufficiently  conceal  his  intelligence 
and  discernment,  they  look  upon  it  as  a  downright 
insult;  although  for  the  moment  they  may  hide  their 
ill  will,  their  malice,  and  hatred. " 

The  love  of  the  psychopathic  patient  is  at  bottom  self- 
love,  it  is  like  the  love  of  the  wolf  for  the  lamb.  Lov- 
er, husband,  child,  friend,  father,  mother,  brother,  sis- 
ter are  all  for  the  patient's  self.  "When  the  attack  is 
on"   exclaimed  a  psychopathic  patient,  affected  with 

cardiac  palpitation  and  intense  fear,  "I  am  too  d d 

scared  about  myself  to  think  about  her!"  The  psy- 
chopathic patient  is  a  parasitic  ogre  with  an  hypertro- 
phied  ego.  Patients  who  claim  to  love  children  when 
the  latter  are  well  and  healthy,  avoid  them,  like  a 
pest,  when  the  children  happen  to  fall  sick,  for  fear  of 
disease  and  for  fear  of  the  sick  children,  producing  an 
evil  influence  on  the  patient's  "sensitive"  nerves.  The 
patient  is  afraid  to  come  near  sickness,  or  even  afraid 
to  hear  of  evil  things,  such  as  descriptions  of  misfor- 
tunes, ailments,  accidents,  and  sufferings,  because  they 
may  upset  him  and  arouse  his  fears  about  himself.  All 
the  patient  wants  is  to  be  surrounded  with  cheer,  joy, 
merriment,  excitement,  and  happiness  which  he  is  una- 
ble to  enjoy.  The  psychopathic  patient  is  in  constant 
search  after  happiness.  Not  that  he  is  interested  in  the 
problem  of  happiness  from  a  moral,  philosophical  or 
even  purely  religious  standpoint.  His  interest  is  of  the 
crudest,  the  meanest,  the  most  selfish  kind.  It  is  hap- 
piness for  self,  a  low,  mean,  short,  and  brutish  self. 


lOO     Causation  and  Treatment^  Psychopathic  Diseases 

Psychopathic  happiness  is  not  human,  it  is  the  an- 
guish of  the  beast,  cornered  by  terror.  The  patient  is 
tortured  by  happiness,  tantaUzed  by  fear.  Egotism, 
fear,  and  ennui  are  the  harpies  of  psychopathic  life. 

I  take  almost  at  random  a  few  quotations  from  the 
writings  of  a  psychopathic  patient,  writings  which 
may  be  regarded  as  typical  of  all  other  patients :  "  What 
truths  must  I  realize  to  become  happy?  How  shall  I 
get  an  absorbing  interest  and  be  happy  .^  How  am  I 
to  feel  happy  about  the  right  things?  What  is  this 
vague  discontent,  because  I  do  not  desire  people's 
welfare  ?  Is  it  wise  for  people  to  get  all  kinds  of  healthy 
happiness  they  can?  (Patient  claims  to  be  scrupulous- 
ly religious,  extremely  conscientious,  and  highly  moral). 
My  happiness  is  affected  by  the  happiness  of  others. 
That  is  as  it  should  be,  is  it  not  so?  .  .  .  Knowing 
my  abilities  and  circumstances  to  what  extent  is  it 
possible  for  me  to  obtain  happiness?  .  .  .  What 
are  the  means  by  which  my  happiness  may  be  brought 
about?  .  .  .  How  far  should  I  pursue  the  happi- 
ness of  others?  .  .  .  What  interest  shall  I  have  or 
cultivate  so  as  to  make  my  life  happy?  .  .  .  I  want 
to  do  the  high  and  the  great.  Must  I  not  grow  from 
the  small  to  the  high?  .  .  .  When  I  get  well  and 
free  from  my  fears  will  I  feel  that  if  I  thought  things 
out  they  would  be  all  wrong  while  I  will  feel  strong 
and  happy?  .  .  .  Should  I  be  contented  to  do 
humdrum  things?  .  .  .  What  is  the  secret  of  great- 
ness and  of  happiness?"     .     .     . 

Psychopathic  patients  subscribe  to  the  "cheerful" 
effusions  of  "New  Thought,"  and  plaster  the  walls 
of  their  rooms  with  elevating  "Rules  for  Health  and 
Happiness." 

The  writings  and  accounts  of  the  patients  are  full  of 
introspection  about  health  and  about  the  minutise  of 
their  feelings  in  the  various  parts  of  their  body.     Some 


The  Impulse  of  Self -Preservation  loi 

of  the  patients  with  a  Uterary  turn  keep  on  writing 
volumes  about  the  most  minute  symptoms  of  their 
trouble  to  which  they  happen  at  any  moment  to  be 
subject.  I  have  numbers  of  manuscripts,  biographies, 
autobiographies  all  telHng  the  same  old  story  of  "bhght- 
ed  lives"  due  to  ill  health,  drugs,  and  treatments, 
all  describing  with  the  over-scrupulous  exactness  of 
microscopic  anatomy  the  different  symptoms  that 
plague  them  by  night  and  day.  The  patients  tell  of 
their  talents  and  remarkable  abilities  superior  to  the 
average  run,  of  their  ill  luck  and  failures,  due  to  their 
unfortunate  state  of  ill  health. 

In  quoting  from  some  of  the  accounts  given  to  me 
by  the  patients  themselves  I  wish  to  attract  attention 
to  this  side  of  the  patient's  mental  condition,  the  ex- 
pression of  the  impulse  of  self-preservation,  manifested 
in  the  general  panic  of  health,  or  fear  of  disease, 
whether  mental,  nervous  or  physical,  phrenophobia,  or 
pathophobia. 

I  give  a  couple  of  illustrations  of  accounts  given  to 
me  by  patients.  These  accounts  of  symptoms  are  put 
by  the  patients  in  the  form  of  precise  bookkeepers' 
inventories.  The  symptoms  are  described  with  the 
most  exacting  minuteness.  Such  summaries  are  often 
accompanied  with  long  winded  annotations  and  ap- 
pendices: 

"S.  P.  S.  Age  forty.  Average  weight  i6o  lbs. 
Married.     Profession,  lawyer  and  author. 

"No  bad  family  history.  No  syphilis,  scrofula,  or 
insanity.   No  organic  disease,  except  enlarged  prostate. 

"Neurasthenia,  perhaps  congenital.  Objects  like 
fishes  floating  before  the  eyes.  Incessant  tinnitus 
aurium.  Occasional  subjective  odors  and  tastes.  Ec- 
zematous  eruptions. 

"These  symptoms  have  appeared  years  ago,  some 
of  them  as  results  of  the  grippe. 


I02     Causation  and  Treatment^  Psychopathic  Diseases 

"Hay-fever  with  asthma  for  years,  a  very  bad 
case.  Produced  great  prostration.  Some  symptoms  of 
this  disease  present  the  year  round.  Occasional  insom- 
nia. Occasional  nocturnal  and  diurnal  horrors.  Ina- 
bility to  remain  quiet  or  composed. 

"Enlarged  prostate, — left  lobe  principally. 

"Uric  acid  diathesis  inherited  from  both  sides,  pro- 
ducing muscular  and  arthritic  rheumatism. 

"Numerous  attacks  of  grippe,  with  great  suscepti- 
bility to  them. 

"Had  all  children's  diseases  but  mumps. 

"Natural  somnambulism  and  sleep- talking  till  pu- 
berty. 

"Great  irritability  of  temper. 

"Occasional  aphasia,  inability  to  pronounce  such 
words  as  "prelate;"  rarely,  slight  stammering. 

"Almost  absolute  lack  of  concentration.  Great  im- 
pairment of  memory.  Occasional  great  depression  of 
spirits.  Occasional  inclination  to  cultivate  obsessions, 
controllable  by  will-power.  Sometimes  experiences  of 
auditory   hallucinations. 

"My  trouble  is  inability  to  work  even  moderately 
without  having  as  after  effects  physical  agitation  and 
heightened  irritability,  shown  in  bodily  sensations,  in 
restless  and  jerky  movements  of  hands  and  feet  and — 
on  occasions  of  suspense  or  conflict — in  violence  both 
of  manual  and  vocal  expression;  the  motor  discharges 
passing,  it  would  seem,  through  the  lower  centers 
without  giving  higher  centers  a  chance  at  them;  for 
will  power  and  higher  control  generally  is  certainly  not 
weakened,  where  there  is  time  for  its  exercise.  (I 
say  'time,'  but  of  course  the  true  differentia  may  be 
something  else).  These  effects  increase  with  continued 
work  till  it  is  manifestly  time  to  stop  and  wait  for  some 
weeks  or  months  till  they  wear  off. 


The  Impulse  of  Self-Preservation  103 

"My  occupation  is  that  of  editorial  writer.  In  it 
I  both  earn  a  hving  and  keep  myself  in  touch  with  the 
material  for  an  investigation  which  is  of  dominant 
interest  to  me,  viz.,  the  social  functioning  of  the  social 
man,  which  involves  on  one  side  the  social  statement 
of  the  theory  of  knowledge,  and  on  the  other  the 
interpretation  of  society  in  terms  of  the  knowing  man. 
Forget  this  detail,  and  remember  only  that  my  main 
interest  and  activity  is  one  which — regardless  of  the 
detail  as  to  whether  my  ultimate  product  is  good  or 
bad — involves  high  pressure  brain  work  while  I  am  at 
it. 

"My  recent  history  is  as  follows:  Three  years  ago 
I  stopped  work  and  began  to  cry  (conventional  style). 
One  year  ago  after  a  return  to  the  office  had  been  fol- 
lowed by  return  to  investigation  I  developed  'emotional 
exaggeration,'  as  described  in  following  memoranda, 
and  also  tendency  to  motor  violence,  as  mentioned 
above.  After  a  summer  on  a  farm,  followed  by  three 
months  of  investigation  (without  office  work)  three  to 
five  hours  a  day,  the  motor  phenomena  are  at  the 
front,  and  I  have  had  to  stop  work  again. 

"Three  years  ago  Dr.  R.  of  this  city  pronounced  me 
physically  sound  all  over,  after  all  the  usual  tests.  He 
has  repeated  the  verdict  this  week,  and  my  reflexes,  etc., 
have  been  tested  and  pronounced  normal  by  a  nerve 
specialist  of  this  city  (rather,  by  his  assistant),  whose 
name  I  omit  because  of  the  nature  of  my  description 
of  his  report  on  me  attached  hereto. 

"I  enclose  herewith:  _ 

"A  memorandum  of  history  of  my  case. 

"Extract  from  a  personal  letter  of  my  own,  describ- 
ing the  examination  I  have  already  received. 

"Memorandum  by  my  wife  in  regard  to  questions  put 
to  her  by  physicians  here. 


I04     Causation  and   Treatment,  Psychopathic  Diseases 

MEMORANDUM 

"Age,  40.     Married  10  years.    Have  had  no  children. 

"Father,  died  65,  bronchitis  and  heart,  etc.  Seden- 
tary Hfe,  placid. 

"Paternal  grandfather,  stopped  work,  poor  health 
35-40.     Died  85,  cancer. 

"Mother,  nervous  till  past  middle  age,  sick  head- 
aches, fidgety  feet. 

"Mother's  near  family,  two  or  three  deaths  by  'pa- 
ralysis. ' 

"Other  grandparents,  one,  cancer  in  old  age;  one, 
cholera  young;  one  young,  cause  of  death  unknown 
to  me  now. 

"My  boyhood:    'nervous  child;'    alleged    'sensitive- 
ness to  noises.' 
"Diseases: 

1 88 1  (age  11)  Vaccination  poisoning.     Sores  on  face 
and  body. 
Effects  lasted  three  or  four  years.     Think  took 
mercury  (?)  pills  for  even  longer  time. 
1886-7     Broke  down  while  in  college  at  D. 

Returned  home  in  N.  in  spring.     Feeble  through 

the  summer.    Note  sharp  and  complete  cessation 

of  self-abuse  two  or  three  months  before  this 

breakdown. 

1888  or '89  Violent  headache.   Astigmatism.  Glasses 

gave  relief. 
1898.     Typhoid    fever.     First    Hght,    then    relapse 
and  delirium. 

Confined  to  room  perhaps  seven  weeks. 
"Occupations: 
School  to  1887. 

'87-'90     In  a  business  office. 


The  Impulse  of  Self-Preservation  105 

'90-'92    J.   H.    University,  undergraduate   work, 

two  years. 
'92-' 96    Graduate  work,  Germany,  Ph.  D., 
'96-'o3     Reporter  and  City  Desk. 
'03-' 10     Editorial  writer. 

Present  trouble: 

"Remember  nothing  to  report  during  college  period, 
nor  reportorial,  save  that  one  time,  perhaps  '03, 
I  combined  unwonted  executive  duties  with  a 
rushing  piece  of  magazine  work  in  midsummer,  and 
was  highly  wrought  up  before  finishing  it. 

"Winter,  'oy-'oS.  Doing  regular  editorial  work,  cor- 
recting proof  sheets  of  a  book  on  government 
that  appeared  in  the  spring  of  '08,  my  father  was 
seriously  sick  for  a  time,  and  certain  business 
matters,  not  my  own,  had  to  be  watched  by  me. 
Result,  February,  '08,  cursed  everybody  in  the 
office  one  day,  wanted  to  run  away,  instead  walked 
home,  had  conventional  hysterics,  and  felt  weak 
enough  to  stay  in  bed  for  a  week  or  more.  Some 
temperature.  A  fool  doctor,  first  comer,  talked 
about  inflammation  of  the  brain,  or  hemorrhages 
or  something  of  the  sort,  but  thorough  examination 
later  showed  blood  pressure  and  everything  else 
normal. 

"March-July,  '08.     Europe. 
Too  much  excitement,  too  many  friends,  too  much 
to  eat  and  drink. 

"July,  '08.  Recalled  suddenly  by  father's  new  sick- 
ness.    His  death  followed. 

"Fall,  '08.     Occupied  by  repellent  business   affairs. 

"December,  '08  to  March,  '10.  With  newspaper 
again. 

"I  did  not  begin  investigations  on  the  lines  of  my 
dominant  interest  until  July  '09. 


io6     Causation  and   Treatment,  Psychopathic  Diseases 

"December,  '09.  Quit  personal  reading  and  investi- 
gation. 

"January,  '10.  Quit  smoking  after  perhaps  18  years 
steady  habit. 

"February,  '10.     A  short  vacation  gave  no  reHef. 

"March,  '10.     Quit  newspaper  work. 

"April-September,  '10.  On  an  Ohio  farm,  leisurely 
work. 

"September-December,  '10.  Took  up  personal  in- 
vestigations, three  to  five  hours  a  day,  five  days, 
perhaps,  a  week.  Gradually  improved  for  six  or 
eight  weeks,  then  grew  rapidly  worse.  Did  not 
return  to  newspaper. 

"December,  '10.     Quit. 
"Body  Conditions: 

Digestion  good.     A  slight  constipation  will  greatly 
increase    feeling    of    agitation    and    irritableness. 
Sometimes  bodily  agitation  seems  localized  along 
oesophagus. 
"Sleep: 

Usually  very  good.  When  I  can  work  I  sleep 
nearer  nine  hours  than  eight.  After  a  motor 
explosion  will  be  exhausted  and  sleep  well.  Of 
late  apt  to  be  wakeful  in  early  morning  hours, 
but  rarely  is  the  wakefulness  combined  with  agita- 
tion. Agitated  wakefulness  was  common  for  a 
short  period  in  spring  of  1910. 

"Morning  hours,  especially  after  breakfast,  worst 
time. 

"Winter.     My  bad  times  have  been  in  winter. 

"Warm  Baths.     Always  soothing. 

"Sex.  Desire  neither  increased  nor  decreased.  Mod- 
erate. 

"Thighs.  Numbness  and  stinging  sensations  in  left 
thigh  in  fall  of  '08.  Did  not  recur  till  fall  of  '10. 
Then  noticed  in  middle  front  of  left  thigh,  and 


The  Impulse  of  Self-Preservation  107 

above  right  knee.  Pains  superficial.  Numbness, 
burning,  stinging,  sometimes  violent  stabbing 
pains,  pressure  sensations.  Noticeable  in  general 
only  when  walking,  but  at  their  worst  also  when 
standing  and  even  when  lying  down.  Sometimes 
caused  me  to  halt,  but  have  taken  long  cross- 
country walks  despite  them.  Pains  have  ceased 
entirely  within  last  month,  since  general  condition 
became  worse, 

"Liquor.  Use  very  little,  even  at  meals.  Purely  a 
social  matter.  Since  days  when  I  was  a  reporter 
the  only  time  of  fairly  steadj^  drinking  was  in 
Paris  in  '08. 

"Smoking.  Became  distasteful  in  winter  months  of 
'09  (Nov.-Dec).  Later  produced  marked  stimula- 
tion of  pulse,  also  seemed  to  increase  irritableness. 
Stopped  entirely  January,  10,  except  for  half  a 
dozen  smokes  last  of  which  preceded  a  slight 
nausea. 

"Mental  condition.  My  private  opinion  is  that  I 
never  could  work  so  elTectively  as  now,  either  as 
regards  fertility  or  balance.  Under  the  conditions 
however,  I  do  not  pretend  to  be  a  judge  of  that. 
By  'effectively'  I  refer  to  tests  entirely  within  the 
work  being  done,  not  to  any  value  the  work  may  or 
may  not  have  by  social  tests. 

"Self-control.  It  seems  stronger,  if  anything,  within 
a  certain  range,  that  is,  I  come  nearer  being  decent 
towards  people  I  meet.  Unfortunately  too  much 
happens,  as  described  below,  that  does  not  get 
within  range  of  will  control. 

"Depression  and  Exaltation.  Neither  appears.  Can 
enjoy  living  thoroughly,  when  I  am  not  working. 

"Fear.  In  '08  was  afraid  of  my  razor.  Had  to  stop 
shaving.     Nothing  of  the  kind  since  then. 

"Suspiciousness.     Imagine  I  had  it  in  strong  form  in 


lo8     Causation  and   Treatment,  Psychopathic  Diseases 

'08,  but  think  not  now,  at  least  no  more  than  nor- 
mal for  me. 

"Emotional  exaggeration,  and  reverberation  of  emo- 
tions. This  was  characteristic  in  the  spring  of  '10, 
when  I  quit  work  and  for  some  time  afterwards. 
If  I  would  think  somebody,  as  my  landlord,  or  some 
condition,  was  wrong,  I  would  begin  to  fume 
inwardly;  I  could  not  shake  off  the  preoccupation. 
I  would  have  the  sense  of  agitation  in  the  body  as 
well  as  the  exaggerated  emotion,  and  the  reverbera- 
tion might  continue  for  hours.  Have  had  a  few 
beginnings  of  such  experiences  this  fall,  but 
nothing  marked.  Looking  back  at  them  they 
appear  as  the  beginnings  of  what  might  have 
become  fixed  ideas.  My  specialized  exaggerations 
never  'stick'  this  way.  I  easily  free  myself  of 
them. 

"  Violence  in  word  and  movement.  The  worst  symp- 
tom now.  Restless  or  jerky  movements  of  hands 
and  feet.  Spluttering  talk  and  sounds  that  I 
haven't  the  slightest  intention  of  producing.  If 
I  am  crossed  on  trivial  matters,  but  especially  in 
arguments  or  reasoning,  or  kept  in  suspense,  I 
become  explosively  irritable.  As  for  instance 
smashing  a  chair  on  the  floor,  tearing  up  papers 
which  I  had  to  wait  to  have  signed,  hitting  a  waiter 
in  the  face  with  a  bill  of  fare  when  he  brought  me 
the  wrong  dish.  All  of  these  things  being  done, 
as  far  as  I  can  tell,  without  my  being  aware  I  was 
going  to  do  them;  but,  of  course,  with  sufficient 
habitual  control  to  prevent  very  destructive  acts 
as  yet. 

"Tendency  to  get  things  finished,  so  as  not  to  be 
bothered  with  thinking  I  still  have  them  to  do. 
Plain  feverish  haste  and  insistence  on  being  busy. 


The  Impulse  of  Self-Preservation  109 

This    Is  normal  with    me,  but    exaggerated   now. 
Have  not  yet  found  the  key  to  a  low-toned  Hfe. 
"Work.     When  in  library  work  I  become  feverish  at 
the  start,  but  can  settle  down  and   retain  good 
concentration  for  five  or  six  hours  unless  definite 
physical   conditions   or   some   varieties   of   noises 
disturb  me. 
"Talkativeness.     A  recent  phenomenon  is  nervous 
talkativeness  under  any  and  all  conditions  where 
normally  I  would  be  silent. 
"Mischief.     When  I  stop  work    it    has    been    very 
difficult  thus  far  to  keep  out  of  any  variety  of 
mischief    that    comes    along.     Such    interference 
must  therefore  be  assumed  at  each  period  described 
above  when   I  have  been   supposed  to  be  resting 
completely. 
"  Fatigue : 

Many  of  the  phenomena  above  described  are  closely 
comparable  with  what  takes  place  on  a  smaller 
scale  after  physical  fatigue;  as,  for  instance,  if  I 
take  an  all  day  cross-country  walk,  have  to  enter- 
tain visitors  in  the  evening  and  get  insufficient 
sleep,  I  would  feel  and  act  next  day  much  as  I  feel 
now  all,  or  almost  all,  of  the  time. 
"  Exercise : 

Usual  recreation  is  long  walks  in  the  country.     Of 
late  years,  however,  rarely  above  twenty  miles. 
Probably    overdo    in    this    under    some    weather 
conditions.     Winters    'oS-'og    and    '09-' lo    have 
done  regular  gymnasium  work." 
Some  of  the  patients  modestly  ask  of  me  to  accom- 
plish for  them  a  few  things  in  one  treatment:     The 
following  is  a  good  type  of  many  others : 

"I  realize  a  few  of  my  greatest  faults  which  I  wish 
you   to  correct.     You   corrected    my  whiskey    habit. 


no     Causation  and   Treatment,   Psychopathic  Diseases 

Now  I  wish  you  to  help  me  along  the  following  lines: 
"(i)     To  continue  to  abhor  whiskey. 

(2)  At  all  times  to  keep  perfect  control  of  my  temper. 

(3)  To  be  enthusiastic  in  taking  exercise  in  the  open 
air  and  otherwise,  and  in  playing  golf,  tennis  and  the 
like. 

(4)  To  have  even  greater  energy  and  application 
in  my  business,  to  be  tireless  and  very  exact  in  reading 
newspapers  and  other  journals. 

(5)  To  be  quicker  and  more  prolific  in  discovering 
hidden  aspects  of  the  news  and  the  developments,  and 
in  producing  feature  articles  and  pictures  having  the 
elements  of  what  is  known  as  'heart',  or  'human 
interest' — that  is,  popular  interest. 

(6)  To  be  to  a  greater  degree  capable  of  attracting 
the  respect  and  confidence  of  superiors  and  inferiors. 

(7)  To  be  fluent — to  a  proper  degree — in  speech, 
and  convincing,  always  retaining  the  command  of  my 
higher  faculties. 

Could  you  give  these  suggestions  at  one  time  ?  I  can 
ill  spare  any  time.  ...  I  am  an  easy  subject." 
Patient  is  a  newspaper  man. 

The  psychopathic  patient  talks  about  his  humanita- 
rian ideals,  about  his  great  abilities  superior  to  the 
common  run  of  humanity,  and  how  with  his  talents 
he  is  willing  and  has  been  willing  to  confer  benefits  on 
poor  suffering  humanity  in  spite  of  the  fact  that  he 
has  to  struggle  with  his  poor  health,  physical,  nervous 
and  mental.  In  spite  of  the  overwhelming  fatigue 
due  to  ill  health,  and  in  spite  of  the  fearful  ideas  and 
impulses  that  have  beset  him  day  and  night  he  still 
has  succeeded  to  fight  his  way  through.  The  patient 
hankers  for  notoriety,  for  praise,  for  appreciation  by 
other  people,  and  is  apt  to  complain  that  the  family, 
neighbors,  acquaintances  and  even  friends  cannot 
appreciate  his  good  points,  his  good  will,  and  his  high 


The  Impulse  of  Self-Preservation  iii 

ideals  to  which  he  conforms  his  Hfe,  tortured  as  it  is 
with  pains  and  suffering  of  poor  health.  The  egocentric 
character  of  the  psychopathic  patient  is  bound  up  in 
his  abnormally  developed  impulse  of  self-preservation 
and  in  his  pathological  state  of  the  fear  instinct. 

Thus  one  patient  opens  his  account  with  the  phrase: 
"From  boyhood  I  had  a  sensitive  conscience." 

Another  patient  writes:  "As  a  child  I  had  a  keener 
instinct  as  to  the  real  unexpressed  attitude  of  those 
about  me  toward  each  other  than  the  average  child. " 

One  of  my  patients,  an  extremely  puny  being  of 
mediocre  intelligence,  writes:  "I  have  always,  from  the 
earliest  childhood,  felt  that  I  was  different  from  those 
about  me;  and  I  must  acknowledge  that  it  was  not 
alone  a  feeling  of  inferiority  on  account  of  poor  control, 
but  a  feehng  that  I  understood  more  than  they.  I 
was,  however,  of  a  delicate  constitution  and  suffered 
from  ill  health." 

The  following  is  a  characteristic  report  made  by  me 
about  the  condition  of  a  psychopathic  patient: 

"He  is  not  interested  in  anything  but  himself  and  in 
his  business  or  money  making  for  self-enrichment. 
Daily,  when  he  is  left  to  himself,  I  have  to  get  a  hold  of 
him,  and  lead  his  mind  away  from  his  supposed  troubles 
and  financial  affairs  over  which  he  worries.  His  central 
state,  almost  delusional  in  character,  is  fear  of  im- 
poverishment. He  is  afraid  he  has  only  a  hundred 
thousand  dollars  which  will  hardly  suffice  for  his  ex- 
penses. (The  patient  is  sixty-five  and  has  no  children). 
His  worry  is  based  on  fear  of  disapprobation  and  possi- 
ble disparaging  opinion  of  his  friends  and  his  acquaint- 
ances in  regard  to  his  failures  in  life.  Being  a  lawyer, 
he  was  never  appointed  to  any  prominent  position. 
He  made  little  money  in  his  investments.  To  this 
should  be  added  the  much  lamented  loss  of  his  wife's 
health  which  might  have  given  him  room  in  the  socia\ 


112     Causation  and   Treatment,   Psychopathic  Disease 

swim.  Conceit,  vanity,  vain -glory,  greed,  ambition, 
grounded  in  a  hypersesthetic  self-consciousness,  asso- 
ciated with  the  fear  of  utter  ruin,  all  go,  as  so  many 
constituents,  to  form  the  patient's  pathological, 
mental  aggregate.  I  have  tried  to  interest  him  in 
various  other  things  than  his  petty  self  and  its  fears. 
I  am  sorry  to  say  that  thus  far  all  my  attempts 
have  not  been  successful.  The  patient  is  too  old,  his 
life  Is  too  firmly  rooted  in  the  impulse  of  self-preserva- 
tion with  its  accompanying  fear  instinct. " 

Here  is  a  characteristic  statement  made  to  me  by  a 
psychopathic  patient: 

"Age  38.  Apparently  in  good  health  except  for  a 
nasal  and  throat  catarrh.  Nose  has  been  operated  upon 
several  times  and  a  considerable  part  of  the  middle 
bone  removed  which  before  had  obstructed  the  air 
passages.  Less  catarrhal  trouble  since  operations. 
Perforation  size  of  pea  left  between  nostrils.  Always 
had  trouble  with  eyes  until  about  four  years  ago  when 
properly  fitted  with  glasses  for  reading.  Eye  trouble 
caused  by  semi-paralysis  of  accommodation  muscles. 
No  eye  trouble  now.  Suffer  during  the  whole  winter 
with  cold  hands  and  feet.  Height  5-9^^,  weight  165. 
Now  practicing  law  and  have  been  engaged  in  like 
occupations  last  ten  years,  except  one  spent  in  mining. 
Mentally  inchned  toward  philosophical  studies.  Fond 
of  outdoor  sports,  trees,  flowers,  etc.  No  excesses  at 
present.  Worked  too  hard  in  early  life  on  farm. 
Nervous  temperament  and  extremely  sensitive  of  others' 
opinions  and  words.  Make  too  much  of  an  attempt  to 
satisfy  the  expectations  of  others.  Have  had  several 
difficulties  at  various  times  with  other  men  which 
resulted  in  considerable  physical  and  mental  compli- 
ments and  honors  paid  to  me.  The  parties  were  always 
much  larger  and  used  foul  methods  and  as  I  am  inclined 
to  use  kindly  methods  and  much  consideration  for  those 


The  Impulse  of  Self-Preservation  113 

weaker  or  inferior  to  myself  these  difficulties  have 
caused  much  mental  worry  and  disturbance.  Have 
attended  a  number  of  prize  fights  and  always  suffer 
extremely  from  increased  heart  action  when  I  see  them, 
or  a  personal  encounter  of  any  kind.  Sleep  lightly  and 
often  wake  with  a  shudder  though  I  have  little  recollec- 
tion of  any  dreams.  Find  heavy  drowsiness  during 
waking  hours.  Unmarried.  Would  probably  have 
been  married  years  ago,  if  financially  able. 

"Always  have  an  indefinable  dread  of  something 
fearful  going  to  happen.  This  is  my  greatest  difficulty. 
I  am  too  sensitive  about  taking  issue  with  others. 
I  have  tried  the  real  estate  business,  but  this  fear  or 
dread  has  prevented  me  from  approaching  others  for 
fear  that  they  might  take  it  as  a  personal  affront,  and 
in  trying  to  be  just  I  have  been  unjust  to  myself. 

"There  is  no  apparent  reason  why  I  should  not 
accomplish  much  for  myself  and  also  do  others  good 
except  this  abnormal  modesty  and  reluctance  to  oppose 
contrary  wishes  of  others.  I  know  I  possess  much 
latent  force,  if  I  can  only  bring  it  forth.  In  trying  a 
case  I  have  little  difficulty.  It  is  when  matters  must 
be  taken  up  personally  outside  a  formal  court  that  I 
suffer.  I  feel  a  natural  antagonism  to  some  people 
and  it  is  almost  impossible  for  me  to  prevent  myself 
opposing  them  on  every  occasion. 

"I  have  felt  for  a  long  time  that  something  not 
apparent  on  the  surface  was  wrong.  I  feel  that  my 
strength  will  come  only  through  some  psychic  cure 
which  the  ordinary  physician  passes  over  as  supersti- 
tion. I  always  believed  that  my  eye  trouble  would 
be  found  to  be  out  of  the  ordinary  and,  though  some 
of  the  best  specialists  prescribed  for  me,  it  was  a 
serious  handicap  until  an  experiment  was  made  at  my 
own  suggestion,  and  I  now  have  stronger  eyes  than  the 
average  man   of   my   age,  though    several   specialists 


114     Causation  and  Treatment,  Psychopathic  Diseases 

advised  me  to  quit  any  work  which  required  reading. 
My  nose  and  throat  are  the  causes  of  much  trouble  yet. 

"I  understand  the  theory  of  suggestion.  I  will 
purchase  any  books  you  direct  and  read  them. 

"The  burden  of  my  plaint  is  that  I  should  be  positive 
whereas  I  am  negative." 

A  patient  of  mine,  a  clerk  of  average  intelligence, 
with  hardly  any  ability,  but  with  plenty  of  selfishness, 
introspection,  and  immeasurable  conceit,  writes  about 
his  ideals  in  life: 

"I  would  ask  that  this  manuscript  be  considered  in 
connection  with  my  other  two  writings.  I  have  already 
partially  covered  this  ground  in  my  autobiography. 
I  should  be  glad  to  have  my  general  outlook  on  life 
considered,  and  to  receive  suggestions  relative  to 
vocations  and  avocations,  since  my  anxieties  regarding 
these  are  inseparably  intermingled  with  my  thoughts 
of  physical  and  mental  health. 

"Of  course,  since  childhood  my  ideals  have  under- 
gone a  gradual  modification.  First,  there  was  the 
religious  motive  of  life:  I  wanted  to  be  a  soldier  of  the 
Cross  and  assist  in  the  regeneration  of  souls  and  their 
preparation  for  the  life  beyond.  .  .  I  began  to 
meditate  upon  ethical  theories.  .  It  appears  that  in 
doing  the  world's  work  the  tendency  is  to  specialize. 
.  .  .  .  In  the  matter  of  choosing  my  employment 
my  own  interest  is  identical  with  the  interest  of  society. 
At  different  times  of  my  life  I  have  fancied  I  had  a 
liking  for  one  calling  or  another.  .  .  My  lines  of 
thought  have  gradually  drifted  Into  the  philosophical 
(patient  means  the  various  occult  scrlbbllngs  about 
'health  metaphysics'),  I  now  ask  myself  why  I 
should  be  a  lawyer,  a  physician,  a  minister,  a  philan- 
thropist or  any  other  special  thing?  I  conceive  that 
a  man's  life  Is  largely  what  circumstances  make  It,  and 
it  may  be,  therefore,  that  I  shall  always  be  a  clerk  In 


The  Impulse  of  Self -Preservation  115 

an  office,  trying  to  be  useful  in  a  small  way;  but  now 
we  are  talking  of  influencing  such  matters  as  far  as  we 
can  by  choice.  I  imagine  that  .perhaps  my  field  is  in 
the  line  of  ethics,  philosophy,  or  whatever  words  may 
be  used  to  signify  the  general  principles  governing 
human  affairs.  My  reasons  for  thinking  so  are  as 
follows :  First,  I  feel  a  strong  interest  in  those  principles 
comparing  to  no  other  interest  in  my  life.  Second,  I 
find  very  few  people  who  seem  to  feel  any  such  interest 
in  such  matters.  Third,  I  believe  such  principles  to  be 
of  supreme  importance.  The  question  is, — Is  my 
position  in  regard  to  general  truths  so  peculiar  that  I 
should  regard  it  my  mission  to  give  those  subjects  more 
attention  in  study  and  expression  than  do  other  men? 

"The  question  I  want  to  settle  is, — Do  other  men 
feel  this  same  philosophical  interest,  realize  the  broad 
field  of  human  obligation,  and  come  down  to  special 
occupations,  not  because  they  are  more  interesting  to 
them  than  the  general  field,  but  because  they  realize 
they  must  specialize  in  order  to  properly  assist  in 
carrying  on  the  world's  work.?  If  this  be  so  then  I  am 
mistaken  in  thinking  I  should  give  particular  attention 
to  general  principles.  But  my  observations  have  gone 
to  show  that  the  average  physician,  lawyer,  merchant, 
or  politician  is  not  interested  in  the  broad  questions  of 
life,  but  only  in  medicine,  law,  business,  or  politics 
caring  little  for  the  relation  of  his  vocation  to  other 
vocations  except  as  he  makes  his  bread  by  it.  Why 
then  if  the  various  departments  of  human  activity 
must  be  correlated,  and  if  the  individuals  making  up 
those  respective  departments  have  no  disposition  to  do 
the  correlating, — should  it  not  be  done  by  those  who 
are  interested  in  the  general  field.?" 

It  means  that  such  work  could  be  and  should  be 
done  by  the  patient,  by  the  philosophical  clerk,  inter- 
ested in  the  general  metaphysics  of  health. 


Ii6     Causation  and   Treatment,  Psychopathic  Diseases 

Such  confessions  can  be  easily  elicited  from  psycho- 
pathic patients  even  in  their  best  moral  states  of 
apparent  diffidence  and  humility.  This  paranoidal 
aspect  of  self-aggrandizment  is  present  in  all  psycho- 
pathic cases.  In  some  this  trait  stands  out  more 
clearly  and  distinctly  than  in  others.  It  is,  however, 
present  in  all  psychopathic  patients,  if  one  observes 
them  closely  and  attentively.  It  is  the  expression  of 
an  intensified  state  of  the  impulse  of  self-preservation 
and  fear  instinct.  In  other  words,  it  is  a  state  of  an 
exaggerated,  hypertrophied  egotism. 

"We  must  appeal  to  a  law  higher  than  the  material 
law"  a  patient  writes  in  his  account.  "I  worried  much 
over  it.  Since  that  time  the  relation  of  mind  and 
matter  greatly  interested  me.  .  .  .  My  health  at 
this  time  failed;  I  lost  appetite  and  strength,  had 
hysterical  symptoms.  I  was  treated  for  general 
neurasthenia "  Psychopathic,  philosophi- 
cal and  ethical  speculations  and  interests  have  their 
sole  source  in  fear  of  sickness  and  self-preservation. 

"One  of  my  anxieties,"  another  patient  writes,  "of 
my  present  life  is  connected  with  my  business  and  my 
relationship  to  my  partners.  I  am  naturally  con- 
scientious and  inclined  to  be  not  only  earnest  and 
sincere,  but  serious.  My  nature,  instincts,  and  desires 
are  not  superficial.  Yet  my  relation  to  the  business  is 
a  superficial  one.  I  am  neither  fitted  by  natural  tastes 
nor  by  training  for  the  indoor,  rather  mechanical,  con- 
ventional, and  routine  processes  upon  which  business 
and  commercial  success  depends 

"Without  the  common  motives  of  an  ordinary 
merchant  (greed)  I  am  placed  in  the  position  of  the 
one  who  lives  not  by  the  usual  and  conventional  stand- 
ards of  right  and  wrong,  but  rather  by  a  more  exalted 
and  a  more  rigid  one  of  his  own  making  which,  un- 
supported by  habit,  and  institutions,  requires  a  greater 


The  Impulse  of  Self-Preservation  iij 

loyalty,  a  higher  resolve,  and  a  firmer  will  than  is 
required  of  the  conventional  and  conforming  citizen. 
Emerson  says  it  demands  something  Godlike  in  one 
who  would  essay  such  a  task,  not  placing  the  same 
values  on  money,  trade,  commerce,  and  profit  as  the 
natural  money  maker  and  money  lover,  and  not  the 
opportunity  to  substitute  and  supplement  the  usual 
motives  by  and  with  the  larger,  and  to  me  more  com- 
pelling, of  community  betterment  and  employee  wel- 
fare  " 

Another  patient  writes  of  himself,  "The  hypersensi- 
tive nervous  systems,  with  the  initial  shock  has  inhibit- 
ed the  development  of  my  highest  potentialities  and 
my  highest  endeavors. "  He  summarises  his  symptoms : 
"  Dread  and  anxiety  about  being  away  from  home  and 
friends,  self-consciousness,  mental  sluggishness,  quick 
fatigue,  inability  for  deep  thought,  general  state  of 
irritability. " 

One  patient  tells  me  that  he  suffers  from  fatigue, 
insomnia,  dullness,  inability  of  concentration  of  atten- 
tion, failure  in  studies,  slowness  of  comprehension,  and 
so  on;  and  yet  he  gives  his  opinion  on  every  conceiv- 
able subject  with  papal  infallibility,  and  hints  at  being 
an  undeveloped,  unappreciated  genius. 

Perhaps  a  few  more  of  my  cases  will  help  one  to 
realize  the  character  and  nature  of  the  psychopathic 
diathesis : 

M.  A.  Age  43,  female,  married.  Sister  and  brother 
died  of  tuberculosis.  When  young,  she  herself  had 
an  attack  of  tuberculosis  from  which,  however,  she 
entirely  recovered.  This  made  her,  from  her  very 
childhood,  think  of  herself  and  of  the  fear  of  death. 
She  is  suffering  from  menstrual  irregularities  with 
scanty  discharges.  She  also  suffers  from  headaches, 
backaches,  indigestion,  intestinal  pains,  borborygmus, 
and  eructations.     Her  mind  is  entirely  engrossed  with 


Ii8     Causation  and   Treatmentj  Psychopathic  Diseases 

herself,  she  is  totally  unable  to  think  of  anybody  but 
herself.  The  whole  world  is  for  her  sake,  and  she  does 
not  scruple  to  utilize  anyone  who  is  wilHng  to  ser\x  her. 
She  will  take  advantage  of  everybody  and  would  not 
care  what  the  feehngs  of  others  might  be  about  her 
extreme  selfishness.  If  she  were  sure  that  no  fine 
or  punishment  would  follow,  she  would  not  hesitate 
to  take  anything  that  belongs  to  others,  no  matter 
whether  it  be  friend  or  enemy,  provided  it  does  her 
good,  drives  away  any  of  her  discomforts  or  fears  of 
disease,  or  gives  pleasure  to  her,  even  if  the  others  were 
in  agony  on  account  of  it.  If  there  were  a  prize  on 
selfishness,  she  would  be  sure  to  fetch  it.  She  is  sure 
to  take  advantage  of  people  who  do  not  know  her 
and  who  practice  the  ordinary  civilities  and  amenities 
of  hfe  in  regard  to  her  When  the  people  refuse  her 
demands  she  does  not  mind  it,  and  goes  to  look  for 
other  victims  who  have  as  yet  no  knowledge  of  her 
temj>erament,  character,  and  sickness.  Everything  is 
legitimate  in  order  to  get  well  and  healthy. 

The  patient  talks  of  high  ideals  and  of  service  to 
humanity,  and  yet  she  has  not  hesitated  to  lure  away 
a  man  who  had  a  wife  and  three  children.  She  made 
him  divorce  his  wife,  who  was  her  bosom  friend,  had 
him  marry  herself.  She  spends  all  his  money  on  her 
"artistic  dresses,"  while  his  former  wife,  the  mother 
of  three  children,  and  his  little  family  are  allowed 
enough  to  keep  them  from  starvation.  The  patient 
goes  around  travelling,  visits  physicians,  cures  herself, 
keeps  on  being  sick  in  various  health  resorts,  learns 
all  kinds  of  fads  and  their  modes  of  healthy  living, 
keeping  away  from  diseases,  wasting  carelessly  her 
husband's  money. 

The  patient  is  in  terror  of  disease  and  of  old  age. 
She  is  in  fear  even  to  think  of  such  things.  She  carries 
around  with  her  all  kinds  of  prescriptions  and  directions 


The  Impulse  of  Self-Preservation  119 

as  to  how  to  avoid  disease  and  old  age.  Everything 
must  be  subservient  to  her  impulse  of  self-preservation 
and  instinct  of  fear.  She  has  dwindled  to  a  parasitic 
existence,  obsessed  with  the  lowest  instincts  of  life. 
She  avoids  all  responsibilities;  all  she  wants  is  to  use 
others  as  much  as  she  can  in  order  to  obtain  for  herself 
the  highest  possible  benefit.  When  she  meets  people 
who  do  not  know  her  she  is  quick  in  taking  advantage 
of  them.  Life  to  her  has  no  duties,  but  rights.  Patient 
is  a  typical  parasite.  She  would  cheerfully  sacrifice 
a  nation  to  get  out  a  mite  of  pleasure,  comfort,  and 
health. 

V.  S.  Age  49,  female.  Married;  no  children.  She 
has  three  sisters  and  two  brothers  who  are  all  well. 
As  a  child  she  lived  in  great  poverty,  she  was  neglected 
and  met  with  accidents  and  scares;  suffered  from  sick- 
ness until  her  little  body  was  emaciated  from  privation. 
She  managed,  however,  to  go  through  school  and  be- 
came a  clerk  in  a  small  store;  she  was  very  careful  of 
her  appearance  which  meant  to  her  a  good  marriage, 
a  comfortable  life.  She  also  took  good  care  of  her 
health  which  was  rather  precarious,  on  account  of  the 
many  colds  and  painful  menstrual  periods,  accom- 
panied by  severe  headaches.  At  the  same  time  on 
account  of  the  poor  life  led,  she  also  suffered  from  some 
obscure  intestinal  troubles,  more  specially  from  severe 
constipation,  relieved  by  frequent  and  large  enemas. 
After  years  of  precarious  health  and  quests  for  happi- 
ness, for  marriage,  she  finally  somehow  succeeded  in 
marrying  a  well-to-do  merchant  in  whose  store  she 
had  worked  as  clerk.  Immediately  after  marriage  she 
rigged  up  a  "beautiful  home  with  rich  mahogany 
furniture"  which  even  the  husband  regarded  with  a 
gasp,  settled  down  to  a  life  of  leisure  and  complete 
idleness,  and  began  to  attend  to  her  health. 


120     Causation  and   Treatment^  Psychopathic  Diseases 

The  patient  gradually  began  to  find  more  and  more 
troubles  with  her  organs,  from  pelvis  and  intestines 
to  the  top  of  the  head.  Nothing  was  quite  right. 
Things  could  be  improved.  As  she  went  on  the  impulse 
of  self-preservation  gained  more  and  more  control  over 
her.  Along  with  this  impulse  the  fear  instinct  gained 
in  strength,  became  more  and  more  extensive,  she 
became  a  psychopathic  sufferer. 

The  patient  became  full  of  fear  which,  by  the  princi- 
ple of  proliferation  and  diffusion,  kept  on  growing  and 
diffusing  in  ever  new  directions  and  spreading  to  ever 
new  associations  and  systems.  The  central  fear  was 
poverty.  Patient  was  afraid  she  might  become  poor. 
This  is  naturally  a  fear  from  her  early  childhood, — the 
fear  of  suffering  in  poverty,  a  fear  which  persisted 
throughout  her  life.  The  fear  became  accentuated  and 
developed  with  time,  it  became  intensified  with  the 
onset  of  menopause.  She  was  afraid  to  spend  money, 
especially  sums  above  a  five  dollar  bill.  No  matter 
how  much  she  tried  to  reason  with  herself  this  fear 
persisted.  She  was  afraid  to  buy  new  things  which 
she  regarded  more  or  less  expensive.  She  was  afraid 
to  put  on  new  dresses,  to  buy  new  furniture,  to  spend 
money  in  any  way.  In  fact,  quite  often  the  fear  was 
so  uncontrollable  that  even  when  she  had  no  thought 
of  threatening  poverty,  she  was  in  a  panic  at  being  con- 
fronted with  expensive  purchases. 

The  fears  then  began  to  spread  to  other  things,  such 
as  giving  away  small  articles  or  loaning  books,  or 
presenting  any  things  or  objects  that  might  be  regarded 
as  expensive  and  valuable.  The  fears  spread  to  other 
activities  of  life  that  might  prove  of  some  importance 
and  value. 

Along  with  it  she  had  fears  of  digestion  and  nutrition, 
nausea,  vomiting,  intestinal  pains,  rectal,  tubal,  and 
ovarian    discomforts,    and    especially    an    inordinate 


The  Impulse  of  Self-Preservation  121 

amount  of  eructation  which  she  had  when  in  a  state 
of  nervous  excitement  over  things  that  did  not  run  the 
way  she  planned. 

The  patient  was  as  obstinate  as  a  mule,  though  claim- 
ing that  she  was  doing  her  best  and  trying  everything 
in  her  power  to  cooperate.  She  was  doing  everything 
in  her  power  to  frustrate  the  physician's  directions, 
claiming  at  the  same  time  that  she  was  doing  her  best, 
scrupulously  following  the  doctor's  directions.  She 
claimed  she  was  nice  to  people  when  she  was  nasty 
and  offensive  to  everybody  who  in  any  way  happened 
not  to  fall  in  with  her  whims  and  caprices.  In  fact, 
even  those  who  went  out  of  their  way  to  please  her  and 
did  everything  in  attending  on  her,  and  helping  her  in 
every  way  day  and  night,  even  those  she  treated  with 
lack  of  consideration,  even  positive  disdain  and  con- 
tempt. She  was  the  incarnation  of  demoniacal  ob- 
session, the  very  type  of  psychopathic  meanness  and 
egotism. 

Patient  abused  and  dominated  her  husband  by  her 
sickness,  troubles,  fainting  and  crying  spells,  headaches, 
moans,  and  weeping.  She  made  him  do  everything  she 
pleased.  In  fact,  she  tyrannized  over  her  husband, 
and  still  she  kept  on  claiming  she  loved  him,  could  not 
for  a  moment  be  without  him,  and  that  on  account  of 
her  extreme  devotion  to  him,  her  will  was  broken. 

She  was  a  regular  termagant,  a  demon  incarnate. 
She  knew  how  to  make  a  scene  and  put  the  blame  on 
somebody  else.  It  was  enough  for  her  to  suspect  what 
her  friends  wanted  her  to  do,  she  was  sure,  out  of 
sheer  mahce,  to  act  the  contrary.  She  was  distrustful, 
spying  on  others,  sneaky,  and  lying  right  and  left 
without  any  scruples;  and  yet  "no  one  was  so  mild, 
so  ideal,  so  kind,  so  affectionate,  so  considerate,  so 
calm  as  she  was."  She  went  around  reciting  poetry 
about  ideals,  health,  and  happiness.     She  even  per- 


122     Causation  and   Treatment,  Psychopathic  Diseases 

suaded  herself  that  she  was  very  educated,  that  she 
was  the  best  business  woman,  the  best  critic,  apprecia- 
tive of  poetry  and  of  art  in  generah  A  veritable  Nero, 
an  "egomaniac,"  devoid  of  all  love  and  human  sym- 
pathy, "she  suffered  so  much,  because  she  was  so 
unusually  altruistic."  A  coyote  in  her  fear,  a  tigress 
in  her  rage,  she  claimed  the  gentleness  of  the  dove  and 
the  innocence  of  the  babe. 

Patient's  talk  was  but  of  self.  Not  for  a  moment 
could  she  fix  her  attention  on  anything  else  but  herself, 
eating,  drinking,  sleeping,  stools,  and  feelings.  Noth- 
ing interested  her  but  herself;  she  ran  from  any  work, 
from  any  occupation,  however  brief  the  time  might 
have  been.  She  could,  however,  talk  of  herself,  of  her 
former  achievements,  of  her  moral,  intellectual  qualities 
by  the  hour  and  by  the  day.  Even  games  did  not 
interest  her,  nothing  but  self,  self,  and  self.  This  was 
so  evident  that  one  of  my  patients  noticed  this 
characteristic  trait  and  described  her  as  "egomaniac." 

Whenever  one  spoke  of  any  great  man  she  was  sure 
to  have  her  opinion  of  him,  might  have  known  him; 
she  was  at  any  rate  superior  to  him.  She  could  give 
her  opinion  on  any  conceivable  subject  in  literature, 
economics,  and  politics.  She  was  cunning  as  a  savage, 
and  treacherous  as  a  wild  brute,  and  yet  she  was  to  all 
appearances  a  veritable  saint,  full  of  suffering  for  the 
sins  of  humanity  and  for  the  faults  of  her  husband 
who  was  "boyish  and  foolish,  whom  she  had  to 
manage,"  and  whom  she  did  control  and  handle  with 
an  iron  rod. 

There  is  no  doubt,  however,  that  she  herself  was 
driven  by  her  intense,  uncontrollable  impulse  of  self- 
preservation  and  by  the  instinct  of  fear.  What 
specially  terrorized  her  was  the  slow  but  sure  extension 
of  the  fear  instinct  to  more  and  more  objects  and  acts. 
The  fear  instinct   kept  on  creeping  on   her,   slowly 


The  Impulse  of  Self-Preservation  123 

choking  the  life  sources  of  her  being.  To  call  the 
patient  "egomaniac"  is  a  mild  descriptive  term, 
"tigress,"  "satan,"  "fiend,"  would  be  more  appropriate 
appellations.  In  her  terror  of  self-preservation  she 
made  hell  for  herself  and  for  others;  she  is  a  fire-brand 
from  hell,  fanned  by  the  furies  of  fear. 

F.  W.  age  47;  female;  married;  has  no  children. 
Patient  claims  to  have  been  an  invalid  from  childhood, 
at  any  rate  she  was  of  extremely  delicate  health;  she 
always  had  to  take  care  of  her  health,  and  had  to  go 
through  all  kinds  of  troubles  and  diseases,  especially 
digestive  and  gastro-intestinal.  At  the  age  of  eighteen 
she  got  married  and  then  her  family  felicity  began. 
She  began  to  complain  of  all  kinds  of  uterine  troubles, 
more  so  after  a  miscarriage.  The  gynecologist  hu- 
mored her  with  all  kinds  of  operations  and  treatments. 
The  fear  of  disease  became  strengthened,  and  finally 
she  cultivated  a  typical  pathophobia;  she  was  in  terror 
of  some  fearful  malady  that  might  possibly  take  pos- 
session of  her. 

Patient  wanted  to  have  somebody  near  her,  other- 
wise she  could  not  stand  it.  This  fear  of  remaining 
alone  dated  from  childhood,  when  at  the  least  discom- 
fort, she  asked  and  screamed  in  terror  for  help.  A 
companion  or  nurse  had  to  be  with  her  day  and  night, 
so  as  to  protect  her  from  any  impending  evil. 

Occasionally,  to  relieve  her  feelings,  in  the  middle 
of  a  conversation,  whether  for  the  sake  of  impressing 
her  family,  her  husband  and  her  physicians  with  the 
gravity  of  her  disease  or  as  a  vent  for  the  rising  instinct 
of  fear,  she  emitted  a  scream,  wild  and  weird  in  char- 
acter, reminding  one  of  the  howling  of  a  timber  wolf,  or 
of  the  wild  whoop  of  an  Indian.  This  was  a  habit  she 
kept  up  from  childhood.  It  was  a  reaction  of  her  fears 
and  a  protection,  inasmuch  as  it  was  a  call  for  help 
which  was  sure  to  attract  attention.     The  family  could 


124     Causation  and  Treatment,  Psychopathic  Diseases 

not  refuse  help  at  hearing  such  an  unearthly  call. 
Later  on  it  was  consciously  and  unconsciously  utilized 
by  the  patient  as  a  rod  to  rule  the  family  and  especially 
her  husband  when  the  latter  happened  to  become  re- 
fractory. The  fear  reaction  was  thus  used  as  a  protec- 
tion and  as  a  weapon  of  offence. 

Things  had  to  run  according  to  her  pleasure  or  else 
she  was  put  in  a  state  of  nervous  excitement  and  fear 
with  its  awful  yell  of  which  the  family  and  the  husband 
were  in  perfect  terror;  they  yielded  unconditionally. 
The  patient  literally  subjugated  her  husband  by  her 
spells  of  fear,  especially  by  the  fearful  acoustic  perfor- 
mance, the  aura,  the  harbinger  of  a  psychopathic 
attack. 

The  patient  was  always  discontented  and  grumpy. 
Nothing  could  satisfy  her,  nothing  was  good  enough 
for  her.  Everything  and  everybody  were  criticized. 
No  matter  how  one  tried  for  her  she  always  found  fault 
with  the  person.  In  fact  the  fault-finding  was  in  pro- 
portion to  the  eagerness  one  tried  to  serve  and  oblige 
her.  The  nurses  are  not  good,  the  servants  intolerable, 
and  people  in  general  are  bad,  mean,  stupid,  and  vulgar. 
She  herself  comes  from  an  "old  New  England  family, 
good  blood," — her  grandfather  was  a  fisherman  and  her 
father  a  petty  tradesman  in  a  small  town.  Patient 
makes  great  pretensions  to  education,  poetry,  art,  and 
drawing.  In  reality  patient  is  quite  dull  and  ignorant, 
but  unduly  opinionated  and  infinitely  conceited. 

G.  A.  Female,  age  63.  Patient  has  been  obsessed 
with  pathophobia  for  over  thirty-five  years.  She  has 
been  to  a  number  of  physicians  and  to  many  sanita- 
riums, looking  for  health  everywhere,  not  finding  it 
anywhere.  The  fears  date  to  her  early  childhood. 
She  was  regarded  as  a  delicate  child,  the  fear  of  disease 
was  strongly  impressed  on  her.  She  went  through  a 
number  of  children's  diseases.     Although   she  had   a 


The  Impulse  of  Self-Preservation  125 

number  of  sisters  and  brothers,  the  child's  supposed 
deUcate  constitution  was  the  fear  and  the  worry  of  the 
parents.  This  fear  was  communicated  to  the  child 
who  for  the  rest  of  her  life  became  a  psychopathic 
patient  with  the  characteristic  developed  impulse  of 
self-preservation  and  intense  fear  of  disease.  She 
could  not  think  of  anybody  but  herself,  everything  had 
to  be  arranged  for  her,  for  her  food,  for  her  sleep,  and 
for  her  rest.  She  kept  on  complaining  at  the  slightest 
change  either  in  herself,  in  others,  or  in  the  arrange- 
ments of  the  house,  or  in  the  weather.  Everything 
had  to  be  arranged  just  as  she  demanded,  otherwise 
she  was  sick,  or  was  going  to  become  dangerously  ill. 

When  about  the  age  of  thirty,  she  married  a  widower 
with  two  children.  She  trained  the  children  to  obey 
her  commands  implicitly,  otherwise  she  resorted  to  the 
rod  of  sickness.  The  pathophobia,  consciously  or  un- 
consciously, became  a  power  which  she  yielded  in  the 
most  tyrannical  way.  The  children,  when  grown  up, 
had  to  sacrifice  themselves  for  the  pleasure  of  the  sick 
step-mother.  They  had  to  stay  with  her  and  minister 
to  all  her  whims  and  fears.  The  very  individuality  of 
the  children  became  almost  obliterated  by  the  persis- 
tent, egotistic  tyranny  of  the  sick  old  step-mother. 
She  was  like  a  regular  vampire,  sucking  the  life  blood 
of  her  family. 

It  goes  without  saying  that  the  same  fear  of  disease 
tamed  her  husband  over  whom  she  ruled  with  an  iron 
hand.  The  least  opposition  to  her  whims  or  her  fears 
of  possible  disease  made  her  so  sick  with  all  kinds  of 
pains  all  over  the  body,  and  specially  in  the  head  and 
intestines  that  the  family  and  the  husband  were  driven 
into  submission. 

The  woman  was  fat,  obese  as  a  hippopotamus,  well 
nourished,  with  a  florid  complexion  and  with  an  appe- 
tite   that   would    shame    a   Gargantua.     The    rarest, 


126     Causation  and   Treatment,  Psychopathic  Diseases 

the  best,  and  the  most  appetizing  dainties  had  to  be  on 
her  table.  She  made  of  her  meals  a  form  of  worship, 
requisite  to  propitiate  the  goddess  of  maladies.  She 
did  not  hesitate  to  take  the  best  morsels  from  the  plates 
of  her  daughter  and  son,  in  order  to  satisfy  her  appetite 
which  was  supposed  to  be  delicate  and  small. 

Patient  was  conscious  of  every  square  Inch  In  her 
body;  she  was  afraid  that  some  form  of  malady  may 
lurk  there.  She  was  a  typical  pronounced  case  of 
pathophobia.  Fear  of  disease  and  quest  of  health  were 
ever  in  her  mind.  She  could  not  talk  or  think  of  any- 
thing else,  but  herself  and  her  symptoms.  She  made 
of  her  daughter  a  poor,  colorless  being,  a  day  and  night 
nurse,  tyrannized  her  by  pitiful  whimpering. 

When  patient  happened  to  wake  during  the  night  for 
ever  so  short  a  period  of  time,  she  did  not  hesitate  to 
wa  ke  her  daughter,  tired  as  the  latter  was  by  her 
constant  attendance  on  this  psychopathic  shrew.  The 
daughter  had  to  wake  up  everybody  who  could  in  any 
way  bring  comfort  to  that  "poor,  old,  suffering  Invalid." 
After  groaning,  moaning,  and  bewailing  her  bitter  lot 
the  Invalid  took  some  medicine  to  appease  the  fear  of 
disease,  also  partook  of  some  nourishing  food  to  keep 
up  her  strength  and  health,  and  went  to  sleep  for  the 
rest  of  the  night. 

As  soon  as  the  old  lady  found  out  that  I  wanted  to 
send  away  her  daughter  and  get  a  regular  attendant  to 
her,  as  soon  as  she  suspected  that  she  was  not  going  to 
have  her  own  way  in  my  place,  as  soon  as  she  scented 
danger,  she  sent  for  her  son,  whimpered  before  him,  and 
without  delay,  decamped  home. 

The  patient  was  many  years  ago  under  the  care  of 
Weir  Mitchell  who  sent  her  to  me  as  a  last  resort. 
Dr.  Weir  Mitchell  characterized  the  patient  as  an 
"American  humbug."  As  a  matter  of  fact,  the  patient 
herself  Is  really  convinced  that  she  Is  on  the  verge  of 


The  Impulse  of  Self-Preservation  127 

death,  and  is  in  terrible  agony  of  her  fears  of  disease, 
fears  which  make  her  quest  for  health  a  matter  of  Ufe 
and  death.  She  is  not  conscious  of  the  fact  that  she  is 
obsessed  by  the  impulse  of  self-preservation  with  its 
accompanying  fear  instinct.  The  patient  has  become 
obsessed  by  parasitic  egotism,  the  quintessence  of 
psychopathic  affections. 

Many  times  during  the  day  she  paced  the  room 
reciting  elevating  passages  from  the  Bible,  from  the 
great  poets,  Emerson  being  her  favorite  writer. 

A  man  thirty-eight  years  old,  married,  highly 
sensitive,  suffers  from  migraine,  is  irritable  and 
restless.  When  about  eight  years  old  he  wandered  in 
the  woods  near  his  house.  An  Itahan  ran  after  him, 
flourishing  a  big  knife.  The  boy  ran  away  in  terror. 
When  he  reached  home,  he  dropped  from  exhaustion 
and  fear.  Once  or  twice,  on  account  of  the  fear  of 
sharp  objects,  he  actually  hurt  himself  when  handling 
knives.  This  increased  his  terror  and  fixed  his  fear. 
The  instinct  of  fear  was  still  further  developed  and 
stimulated  by  a  series  of  events,  such  as  falling  into  a 
river,  from  which  he  was  saved.  He  does  not  like  to 
take  baths,  is  afraid  to  enter  water,  especially  a  river, 
and  is  in  terror  of  sharp  objects,  such  as  knives  and 
razors. 

Patient  is  extremely  irritable,  selfish.  He  insists 
on  playing  games  which  he  likes  much,  irrespective 
of  the  pleasure  of  his  friends  and  acquaintances.  All 
he  cares  for  is  to  have  a  good  time,  forget  all  his 
duties  to  his  family.  In  his  business  he  is  exacting 
of  others,  although  he  himself  is  rather  slovenly  in 
his  work,  and  slow  in  the  performance  of  his  obliga- 
tions, but  he  is  unreasonable  with  all  his  associates, 
and  can  not  get  along  with  them.  He  always 
insists  on  having  his  own  way.  Other  people's  rights 
do   not   trouble   him    provided    his     rights    are    care- 


128     Causation  and  Treatment^  Psychopathic  Diseases 

fully  and  scrupulously  observed.  He  always  de- 
mands services  from  others,  especially  from  his 
friends.  His  mind  is  occupied  with  himself,  with  his 
health,  his  fears,  and  his  ailments.  The  interest  he 
takes  in  his  friends  and  acquaintances  is  how  far  they 
may  serve  his  purposes  of  pleasure,  game,  health,  and 
avoidance  of  fear  of  disease.  Even  his  own  family  is 
treated  in  the  same  way.  His  wife  and  child  are 
regarded  from  the  personal  standpoint  of  his  own  good 
and  evil,  otherwise  they  are  totally  ignored.  When 
they  interfere  with  him  or  arouse  his  fears  he  becomes 
impatient,  angry,  and  furious.  He  claims  to  be  the 
most  considerate,  and  kindest  of  men,  brimful  of  ideals 
and  humanitarian  ideas.  He  thinks  that  he  can 
accomplish  more  than  any  one  else  in  his  circumstances. 
Nothing  is  too  good  for  him,  nothing  is  superior  to 
him.  As  a  rule  things  are  badly  conducted,  he  finds 
fault  with  everybody  and  with  everything.  He  is 
persecuted  by  the  three  psychopathic  furies, — fear, 
egotism,  and  ennui. 


CHAPTER  XII 

NEURON  ENERGY  AND  NEUROSIS 

IN  my  Work  on  "  The  Symptomatology  of  Psycho- 
pathic Diseases"  I  pointed  out  the  importance  of 
the  various  levels  of  Energy  in  relation  to  a 
classification  of  nervous  and  mental  diseases. 
This  same  doctrine  of  various  levels  of  energies  is  also 
of  importance  in  the  study  of  the  causation  and 
treatment  of  psychopathic  maladies.  To  this  we  must 
also  add  the  Principle  of  Reserve  Energy,  developed 
by  Professor  James  and  by  myself  independently. 
Perhaps  a  review  of  these  principles  will  help  the  student 
to  see  the  matter  in  a  clear  light. 

The  neuron  may  be  regarded  as  the  reservoir  of 
energy,  nervous  and  mental.  The  various  manifestations 
of  nervous  and  mental  activities  may,  therefore,  be 
regarded  as  fluctuations  of  neuron  energy.  We  may 
fully  agree  with  Sachs  who  proposed  to  term  the  cell 
an  energid.  This  designation  holds  specially  true  of 
the  neuron. 

The  total  energy  of  the  neuron  may  be  classified  into 
dynamic  energy,  static  energy,  and  organic  energy. 
The  various  nervous  and  mental  diseases,  classified 
by  me  into  psychopathies,  neuropathies,  organopathies, 
may  be  correlated  with  the  flow  and  ebb  of  neuron 
energy,  with  the  physiological  and  pathological  pro- 
cesses that  take  place  in  the  neuron  in  the  course  of  its 
activity  and  reactions  to  the  stimuli  of  the  external  and 
internal  environment. 

The  various  portions  of  neuron  energy  in  the 
adjustments  to  the  environmental  conditions  may  be 
represented  by  the  following  diagram: 

129 


130     Causation  and  Treatment,  Psychopathic  Diseases 


"   S   s" 
So"     21 


3     ei     >i> 


oil" 

a 
S!S2 


^  :^ 


T 


II 


1 
i 

i 


8* 
ll 

a  "».,'? 


n 
.'I 


i 

'") 

•*. 

<=R 

Si 

|z 

ffii 

ZS 

1^ 
S 

ilJ 

Static  energy  is  indicated  by  the  diagram  N  W  F   I. 

By  organic  energy  is  meant  that  energy  contained  in 
the  very  structure  of  the  tissues  of  the  neuron,  not  as 
yet  decomposed  into  their  inorganic  constituents.  This 
is  indicated  by  diagram  I  F  G  H. 

These  phases  of  neuron  energy  are  not  different 
kinds  of  energy,  in  the  sense  of  being  distinct  entities; 
they  merely  represent  progressive  phases  or  stages  of 
the  same  process  of  neuron  activity. 

Liberation  of  neuron  energy  is  correlative  with  active 
psychic  and  physical  manifestations.  Hence  states 
of  the  nervous  system  corresponding  to  liberations  of 


Neuron  Energy  and  Neurosis  131 

energy  are  designated  as  waking  states.  Restitution 
of  expended  energy  or  arrest  of  liberation  of  neuron 
energy  goes  hand  in  hand  with  passive  conditions  of 
the  nervous  system;  hence  states  of  restitution  or 
arrest  of  energy  are  termed  collectively  sleeping  states. 

The  ascending  arrow,  indicating  the  process  of 
restitution  of  energy,  corresponds  to  the  ascending 
arrow  on  the  right,  indicating  the  parallel  psychomotor 
sleeping  states.  The  descending  arrows  indicate 
physiological  and  pathological  processes  of  liberation 
of  energy,  and  also  their  concomitant  psychomotor 
waking  states. 

"Ascending"  and  "descending"  mean  the  rise  and 
fall  of  the  amount  of  neuron  energy,  taking  the  upper 
level  of  dynamic  energy  as  the  starting  point.  Briefly 
stated,  descent  means  liberation  of  energy  with  its 
concomitant  psychomotor,  waking  states.  Ascent 
means  restitution  of  energy  with  its  parallel  sleeping 
states. 

The  cycles  in  dynamic  energy  correspond  to  the 
physiological  manifestations  of  the  nervous  system  in 
the  activity  and  rest  of  the  individual  in  normal  daily 
life.  Concomitant  with  the  expenditure  of  dynamic 
energy  of  the  neurons,  the  individual  passes  through 
the  active  normal  waking  state,  and,  hand  in  hand  with 
the  restitution  of  this  expended  dynamic  energy,  he 
passes  through  the  sleeping  state  of  normal  daily  life. 

When,  however,  in  the  expenditure  of  energy,  the 
border  line  or  margin,  A  K  or  N  W,  is  crossed,  dynamic 
and  reserve  energies  are  used  up,  and  reserve  and 
static  energy  are  drawn  upon.  In  crossing  A  K  or 
N  W  the  border  line  that  separates  the  normal  physio- 
logical from  the  abnormal  or  pathological  psychomotor 
manifestations  is  stepped  over. 

"The  thresholds  of  our  psychological  systems  are 
usually  raised,  mental  activity  working  in  the  course  of 


132     Causation  and  Treatment^  Psychopathic  Diseases 

its  development  and  growth  of  associative  processes 
under  ever-increasing  inhibitions  with  ever-higher 
thresholds.  .  .  .  On  account  of  the  high  thresholds 
and  inhibitions,  not  the  whole  amount  of  the  psycho- 
physiological energy,  possessed  by  the  system,  is 
manifested;  in  fact,  but  a  very  small  portion  is  displayed 
in  response  to  stimuli  coming  from  the  habitual 
environment.  What  becomes  of  the  rest  of  the  unused 
energy?     It  is  stored,  reserve  energy. 

"Biologically  regarded,  we  can  well  see  the 
importance  of  such  stored  or  reserve  energy.  In  the 
struggle  for  existence  the  organism  whose  energies  are 
economically  used  and  well  guarded  against  waste  will 
meet  with  success  in  the  process  of  survival  of  the 
fittest  or  will  have  good  chances  in  the  process  of 
natural  selection.  The  high  thresholds  and  inhibitions 
will  prevent  hasty  and  harmful  reactions,  useless  waste 
of  energy,  unnecessary  fatigue,  and  states  of  helpless 
exhaustion.  Moreover,  natural  selection  will  favor 
organisms  with  ever  greater  stores  of  reserve  energy, 
which  could  be  put  forth  under  critical  conditions  of 
life.  In  fact,  the  higher  the  organization  of  the 
individual,  the  more  varied  and  complex  the  external 
environment,  the  more  valuable  and  even  indispensable 
will  such  a  store  of  reserve  energy  prove  to  be." 

Static  energy  may  be  divided  into  two  phases, 
according  to  the  nature  of  the  process  of  liberation  of 
neuron  energy.  As  long  as  the  process  of  liberation 
of  energy  effects  only  a  dissociation  of  systems  of  neurons 
the  correlative  psychomotor  manifestations  fall  under 
the  category  of  psychopathies.  If,  however,  the  process 
of  liberation  affects  the  neuron  itself,  bringing  about  a 
disintegration  of  its  constituent  parts  compatible  with 
restitution,  the  correlative  psychomotor  manifestations 
fall  under  the  category  of  neuropathies.  This  process 
of  disintegration,  equivalent  to  cell  degeneration  may 


Neuron  Energy  and  Neurosis  133 

end  in  death,  in  the  dissolution  of  the  neuron  itself. 

When  the  dynamic  energy  is  used  up  in  the  course 
of  life  adaptations  and  the  reserve  energy  is  drawn 
upon,  there  may  be  the  danger  that  the  energy  may 
be  used  until  the  static  energy  is  reached  and 
the  neuropathic  conditions  are  manifested.  These 
conditions,  however,  are  preceded  by  psychopathic 
disturbances  which  involve  the  associations  of  neurons. 
Associative  life  becomes  disturbed,  unbalanced,  and 
emotional  reactions  become  more  violent  and  more 
frequent.  On  the  one  hand  there  is  a  reversion  to 
lower  forms  of  mental  activity  and  lower  instincts, 
especially  to  the  impulse  of  self-preservation  with 
the  instinct  of  fear,  and  on  the  other  hand  the  reactions 
of  the  emotions  become  more  intense  and  pathological, 
since  the  governing  action  of  intelligent  self-control 
is  absent. 

In  such  cases, as  I  have  pointed  out  in  this  and  in  my 
other  works,  the  lower  instincts,  especially  that  of  self- 
preservation  and  fear  will  prevail.  The  patient  will  be 
tortured  by  his  selfish  fears  of  protection  of  his  individu- 
ality against  the  supposedly  terrible  dangers  that  threat- 
en his  Ufe  existence.  The  patient  will  then  be  obsessed 
by  his  fears  and  by  his  wishes  flowing  out  of  his 
fear  and  deranged^  intensified,  uncontrollable  impulse  of 
self-preservation.  The  fear  Instinct  when  reaching  a 
certain  intensity  may  give  rise  to  functional  patho- 
logical changes  in  glandular  secretions,  also  In  the 
metabolism  of  cytoplasm  and  nucleus  of  the  neuron, 
and  may  finally  bring  about  actual  degenerative 
changes  In  the  body  of  the  neuron.  One  cannot  help 
quoting  Dr.  Crile: 

"Fear  is  born  of  the  innumerable  Injuries  which  have 
been  inflicted  in  the  course  of  evolution.  Fear,  like 
trauma,  may  cause  physiologic  exhaustion  of  and 
morphologic   changes   in   the   brain-cells.     The  repre- 


134     Causation  and   Treatment,  Psychopathit    Diseases 

sentation  of  injury,  which  is  fear,  being  elicited  by 
phylogenetic  association,  may  be  prevented  by  the 
exclusion  of  the  noci-association  or  by  the  adminstration 
of  drugs  like  morphine  and  scopolamin,  which  so  impair 
the  associational  functions  of  the  brain-cells  that 
immunity  to  fear  is  established.  Animals  whose 
natural  defence  is  in  muscular  exertion,  among  which  is 
man,  may  have  their  dischargeable  nervous  energy 
exhausted  by  fear  alone,  or  by  trauma  alone,  but  most 
effectively  by  the  combination  of  both. 

"Under  the  dominance  of  fear  or  injury,  however, 
the  integration  is  most  nearly  absolute  and  probably 
every  expenditure  of  nervous  energy  which  is  not 
required  for  efforts  toward  self-preservation  is  arrested; 
hence  fear  and  injury  drain  the  cup  of  energy  to  the 
dregs. 

"Fear  influences  every  organ  and  tissue;  each  organ 
or  tissue  is  stimulated  or  inhibited  according  to  its  use 
or  hindrance  in  the  physical  struggle  for  existence.  .  . 
The  exhaustion  following  fear  will  be  increased  as  the 
powerful  stimulus  of  fear  drains  the  cup  of  nervous 
energy,  even  though  no  visible   action  may  result." 

As  the  static  energy  is  reached  and  with  the  lack  of 
functional  energy  especially  of  the  dynamic  character, 
that  kind  which  is  habitually  utilized  in  the  ordinary 
relations  of  life,  the  patient  will  experience  a  mon- 
otony and  a  void  in  his  life  activity.  He  will  have 
a  feeling  that  something  is  wanting  for  his  happiness; 
he  will  feel  a  craving  for  ever  new  stimulations,  and 
will  tear  around  for  ever  new  impressions  and  excite- 
ments; he  will  be  restless  and  ask  for  ever  new  amuse- 
ments and  distractions.  He  will  do  anything  and 
everything  to  fill  up  this  gap  of  his  life,  because  life 
appears  to  him  empty  and  devoid  of  all  interest;  he 
will  talk  of  ennui  and  even  of  suicide,  and  will  be  of  a 
pessimistic  turn  of  mind,  and  as  such  will  approach 


Neuron  Energy  and  Neurosis  135 

closely  to  melancholic  condition.  He  will  crave  for 
new  pleasures  and  enjoyments,  but  will  soon  tire  of 
them  and  ask  for  others.  He  will  be  in  the  condition 
of  a  leaking  barrel,  the  more  one  pours  into  it  the  more 
is  required  to  fill  it. 

The  restlessness,  this  misery  of  craving  for  new  pleas- 
ures and  excitements  to  still  the  pangs  of  the  fear  in- 
stinct with  its  gnawing,  agonizing  anxiety,  brings  the 
patient  to  a  state  in  which  he  is  ready  to  drink  and 
to  use  narcotics  of  all  kinds  of  description.  What 
the  patient  needs  is  some  way  of  reaching  his  re- 
serve energies  and  bring  about  an  absorbing  interest 
so  as  to  take  him  out  of  the  misery  of  monotony  and 
ennui  of  life,  save  him  from  the  listlessness  and  in- 
difference into  which  he  is  apt  to  fall.  Such  a  state  of 
misery  is  to  him  unbearable.  Something  must  be  done 
to  free  himself  from  the  depression  of  spirits  and  from 
the  low  level  of  energies  and  the  self-fear  instincts  from 
which  he  suffers  such    agonies. 

The  constant  craving  for  stimulation,  this  reaction 
to  the  anxiety  of  the  morbid  fear  instinct,  is  the 
expression  of  the  state  of  exhaustion  of  available 
dynamic  energy  for  the  purposes  of  life  activity.  The 
patient  attempts  to  draw  on  his  latent  reserve  energy; 
since  this  form  of  energy  is  not  accessible  to  the  stimula- 
tions of  common  life,  he  tries  to  release  the  energy  by 
means  of  artificial  stimuli,  be  it  morphine,  alcohol  or 
by  other  stimuli  of  an  excitatory  character.  The 
very  craving  for  affection,  sympathy,  attraction  of 
attention,  love,  and  more  especially  love  of  a  sexual 
character  are  all  expressions  of  the  same  tendency  of 
endeavoring  to  stimulate  to  activity  some  sources  0/ 
dynamic  energy.  The  low  ebb  of  dynamic  energy 
drives  the  individual  to  resorting  to  means  by 
which  he  can  whip  himself  into  new  forms  of  liberation 
of  neuron  energy.      The  impulse  of  self-preservation 


136     Causation  and   Treatment,  Psychopathic  Diseases 

drives  the  organism  to  the  finding  of  new  ways  by  which 
it  can  keep  itself  in  existence.  The  psychopathic  patient 
is  driven  by  fears,  by  fears  of  life  and  death.  The  very 
wishes  of  the  psychopathic  individual  flow  from  the  fears 
of  self-preservation. 

What  the  psychopathic  individual  is  unable  to 
accomplish  the  physician  has  to  do  for  him.  The 
psychopathologist  must  make  a  close  psychognosis  of 
the  case,  he  must  learn  all  the  factors  that  have  brought 
about  the  present  state,  change  accordingly  the  condi- 
tions of  living,  if  this  be  possible;  moderate  the 
intensity  of  the  impulse  of  self-preservation  with  its 
fear  instinct;  stimulate  the  patient  to  activity,  and 
above  all  in  various  ways  to  liberate  in  the  patient 
the  locked-up  sources  of  reserve  energy.  Once  the 
sluices  are  opened  the  amount  of  energy  coming  is 
sufficient  to  drive  away  the  psychopathic  state. 

In  studying,  by  a  close  psychognosis,  the  various 
cases  of  psychopathic  affections  I  wish  especially  to 
attract  the  student's  attention  to  the  fact  that  fatigue, 
whether  physical,  nervous,  or  mental,  plays  an  important 
role  in  the  condition  of  the  patient.  Again  and  again 
in  giving  account  of  his  condition  the  patient  will  tell 
of  the  fact  that  in  the  case  of  fatigue,  whether  he  thinks 
he  experiences  it  or  whether  there  is  an  actual  state  of  it, 
that  is,  whether  hallucinatory  or  real,  the  psychopathic 
symptoms  come  to  the  fore-ground  in  an  ever  more 
uncontrollable  condition.  "Extreme  fatigue"  says 
Mosso  "whether  intellectual  or  muscular,  produces  a 
change  in  our  temper,  causing  us  to  become  more 
irritable;  it  seems  to  consume  our  noblest  qualities — 
those  which  distinguish  the  brain  of  civilized  from  that 
of  savage  man.  When  we  are  fatigued  we  can  no 
longer  govern  ourselves,  and  our  passions  attain  to 
such  violence  that  we  can  no  longer  master  them  by 


Neuron  Energy  and  Neurosis  137 

reason. "  Mosso  gives  an  account  of  his  own  condition 
during  states  of  fatigue. 

"Education,  which  is  wont  to  curb  our  reflex  move- 
ments, slackens  the  reins  and  we  seem  to  sink  several 
degrees  in  social  hierarchy.  We  lose  the  ability  to 
bear  intellectual  work,  the  curiosity  and  the  power  of 
attention,  which  are  the  most  important  distinguishing 
characteristics  of  the  superior  races  of  man.  Persons 
who  suffer  from  affections  of  the  nervous  system  are 
usually  irascible.  We  see  that  hysteria  is  a  condition 
of  the  nervous  system  comparable  to  that  produced 
by  fatigue."  Mosso  works  with  the  ergograph  in  his 
study  on  the  various  states  of  fatigue — muscular,  nervous 
and  mental.  "One  of  my  colleagues  who  sometimes 
forgets  the  time,  as  he  says,  feels  great  weakness  of 
vision  after  having  given  too  long  a  lecture.  This 
phenomenon  appears  especially  at  the  beginning  of 
summer,  when  the  excessive  heat  affects  his  digestion. 
Any  slight  brain  fatigue,  particularly  a  lecture  of  an 
hour  and  a  half,  is  then  sufficient  to  obscure  his  sight 
so  much  that  he  cannot  read.  This  asthenopia  arises 
from  exhaustion  of  the  nervous  system,  and  disappears 
a  few  hours  after  he  has  finished  lecturing." 

Fatigue  or  being  easily  fatigued  is  a  trait  of  psycho- 
pathic affection.  Almost  without  exception  psycho- 
pathic patients  complain  that  they  cannot  keep  long 
their  attention  on  anything,  especially  on  subjects  that 
require  concentration  and  close  intellectual  activity. 
In  such  cases  they  complain  that  they  get  easily 
fatigued.  In  fact  some  patients  as  a  matter  of  defence 
may  suffer  from  asthenopia.  They  complain  that  on 
reading,  if  continued  long,  about  an  hour  or  more, 
specks  begin  to  appear  before  the  eyes;  the  field  of 
vision  becomes  darkened,  as  if  a  cloud  or  mist  hangs 
over  them,  the  page  begins  to  rock,  the  words  move, 
everything  begins  to  swim  before  the  eyes,  so  that  the 


138     Causation  and  Treatment,  Psychopathic  Diseases 

patients  must  quit  their  reading,  or  their  work,  such 
as  knitting  or  crocheting. 

The  same  holds  true  in  the  case  of  concentration  of 
attention  on  a  difficult  subject  that  requires  persistent 
effort  of  thought,  or  persistent  muscular  activity,  even 
if  the  latter  is  not  otherwise  exhausting,  as  far  as  the 
physical  side  is  concerned.  Some  patients  when  the  dis- 
ease is  at  its  height  cannot  concentrate  their  attention 
even  as  much  as  five  minutes.  Their  attention  keeps 
roaming,  and  cannot  remain  on  the  same  subject  for 
any  appreciable  length  of  time. 

The  same  holds  true  with  motor  activities,  the  pa- 
tients are  restless,  they  cannot  sit  for  a  couple  of  min- 
utes in  the  same  place,  they  cannot  keep  still  in  the 
same  position;  their  limbs  keep  on  wiggling  all  the 
time,  their  fingers  keep  on  moving,  beating  tattoos,  the 
muscles  of  the  face  keep  on  twitching  or  moving 
slightly.  The  energy  is  not  banked  up,  it  is  not  steady 
in  its  discharge,  the  reactions  are  not  synthesized,  they 
are  not  integrated.  There  is  a  sort  of  a  constant  leak 
of  neuron  and  muscular  energy  in  response  to  slight 
external  and  internal  stimuli. 

This  condition  is  manifested  by  the  consciousness 
of  extreme  fatigue  at  the  least  exertion,  physical  or 
mental,  and  also  by  the  symptoms  of  fatigue  on  awaken- 
ing. The  patients  sleep  restlessly;  sleep  does  not  give 
them  recuperation,  they  feel  even  more  fatigued  on 
awakening  than  on  going  to  sleep.  The  patients  can- 
not find  any  rest  for  themselves. 

"However  little  attention"  Mosso  writes  in  another 
place  "we  may  have  given  to  the  subject,  we  are  all 
aware  that  after  too  long  a  walk,  or  after  any  violent 
exercise,  such  as  gymnastics,  fencing,  or  rowing,  we 
are  less  fit  for  study.  It  is  true  that  sometimes  after 
moderate  exercise  intellectual  work  seems  to  become 
easier;  this  arises  from  the  stimulating  effect  of  muscular 


Neuron  Energy  and  Neurosis  139 

work,  which  we  shall  have  occasion  later  to  consider 
at  length.  The  best  example  of  the  incapacity  for 
attention  produced  by  muscular  fatigue  is  given  by 
Alpine  ascents.  Only  with  great  difficulty  could 
Saussure  do  a  little  intellectual  work  on  Mont  Blanc. 
'When  I  wished  to  fix  my  attention  for  a  few  consecutive 
moments,  I  had  to  stop  and  take  breath  for  two  or 
three  minutes.' 

"  In  my  own  case  I  have  observed  that  great  muscular 
fatigue  takes  away  all  power  of  attention,  and  weakens 
the  memory.  I  have  made  several  ascents.  I  have 
once  been  on  the  summit  of  Monte  Viso  and  twice  on 
that  of  Monte  Rosa,  yet  I  do  not  remember  anything 
of  what  I  saw  from  those  summits.  My  recollection 
of  the  incidents  of  the  ascents  becomes  more  and  more 
dim  in  proportion  to  the  height  attained.  It  seems  that 
the  physical  conditions  of  thought  and  memory  become 
less  favorable  as  the  blood  is  poisoned  by  the  products 
of  fatigue,  and  the  energy  of  the  nervous  system  con- 
sumed. This  is  the  more  singular  in  my  case,  because 
I  have  a  good  memory  for  places. 

"Several  Alpinists  whom  I  consulted  agreed  with  me 
that  the  last  part  of  an  ascent  was  least  distinctly 
remembered.  Varracone,  the  barrister,  well  known 
for  his  daring  ascents,  one  of  the  most  distinguished 
writers  belonging  to  the  Italian  Alpine  Club,  told  me 
that  he  was  obliged  to  take  notes  during  an  ascent, 
because  on  his  return  in  the  evening  he  remembered 
almost  nothing.  The  following  day,  when  the  fatigue 
had  passed  off,  many  particulars  recurred  to  his  memory 
which  he  believed  he  had  entirely  forgotten. 

"Pinel,  the  founder  of  modern  psychiatry,  who 
towards  the  end  of  the  eighteenth  century  was  Professor 
of  Mental  Diseases  in  Paris,  showed  that  political 
revolutions  profoundly  affect  the  nervous  system  of  a 
nation,  and  bring  about  an  increase  in  the  number  of 


140     Causation  and  Treatment^  Psychopathic  Diseases 

the  insane.  The  last  civil  war  in  America  was  a  sad 
confirmation  on  a  large  scale  of  this  statement,  and 
important  papers  were  published  bearing  on  this  point. 
Among  others  that  of  Professor  Stokes  deserves  mention 
as  containing  very  curious  psychological  documents. 

"Sclerosis  of  the  brain  often  results  from  prolonged 
emotion  and  cerebral  overstrain.  Just  as  a  paralysis 
of  the  spinal  cord  may  be  produced  by  forced  marches, 
so  likewise  may  a  paralysis  of  the  nervOus  system  be 
produced  by  cerebral  exhaustion.  I  shall  return  to 
this  later  when  I  bring  together  for  closer  comparison 
the  phenomena  of  muscular  and  those  of  nervous 
fatigue. 

"Political  men,  with  few  exceptions,  wear  themselves 
out  by  overwork  and  age  very  rapidly.  The  corre- 
spondence of  Cavour  is  full  of  allusions  to  the  sleepless 
nights  and  the  profound  exhaustion  both  of  body 
and  of  mind  which  his  political  campaigns  cost  him. 
Scarcely  had  the  law  abolishing  religious  corporations 
been  passed  (to  quote  a  single  example)  when  we  find 
him  writing  to  M.  De  la  Rive:  'After  a  keen  struggle, 
a  struggle  carried  on  in  Parliament,  in  the  salons,  at 
Court  and  in  the  street,  and  rendered  the  more  painful 
by  a  crowd  of  distressing  circumstances,  I  find  my  in- 
tellectual powers  exhausted,  and  have  been  forced  to 
seek  recuperation  by  several  days'  rest.  Thanks  to  my 
natural  elasticity,  I  shall  soon  be  able  to  take  up  the 
burden  of  office  once  more,  and  before  the  end  of  the 
week  I  expect  to  have  returned  to  my  post.' 

"In  Cavour's  letters  a  happy  expression  has  struck 
me,  which  he  uses  several  times  to  indicate  a  physiologi- 
cal conception,  the  necessity,  namely,  of  rest  after 
excessive  mental  work.  He  says  that  one  must  let 
the  brain  lie  fallow,  like  a  field  which  is  allowed  to 
rest,  so  that  it  may  be  sown  again  the  next  year. 

"Another  of  our  greatest  politicians,  whose  life  was 


Neuron  Energy  and  Neurosis  141 

worn  out  by  excessive  work,  was  Quintino  Sella.  I 
was  one  of  his  friends,  being  bound  to  him  no  less  by 
gratitude  than  by  the  great  admiration  which  I  had  for 
him.  In  the  last  year  of  his  life  I  was  often  with  him, 
and  was  among  the  first  summoned  to  his  death-bed. 
I  informed  myself  of  the  details  of  his  last  illness,  and 
was  convinced  that  he  died  from  the  effects  of  cerebral 
overstrain.  He  suffered  from  a  prolonged  and  excessive 
fatigue  which  slowly  destroyed  his  forces. 

"Originally  robust  and  endowed  with  great  energy, 
he  would  fight  to  the  very  last,  and  in  the  effort  over- 
stepped the  limit  of  possible  recovery. 

"I  recollect  that  he  made  an  appointment  with  me 
for  seven  o'clock  in  the  morning,  and  for  me  who  sleep 
well  this  was  an  unwonted  hour  in  winter.  But  in  the 
evening  after  dinner  even  he  was  fatigued,  and  being 
overcome  with  sleep  could  not  maintain  the  conversa- 
tion. How  different  he  was  in  those  last  years  from 
the  time  I  first  knew  him  on  the  Alps  or  in  the  dis- 
cussions at  the  Lincei.  His  will,  his  energy,  his  political 
skill,  were  exhausted,  and  we  regarded  him  anxiously 
feeling  great  uneasiness  about  him. 

"I  have  questioned  several  of  my  friends  who  have 
held  office  in  the  Government  upon  the  subject  of 
overstrain.  One  of  them  writes  to  me  that  he 
experienced  the  greatest  fatigue  when  he  had  to  give 
audience.  When  he  had  to  receive  numerous  visitors 
in  the  evening,  tired  as  he  was  with  the  day's  work, 
and  to  cudgel  his  memory  for  forgotten  details,  the 
effort  became  insupportable.  For  the  sake  of 
exactitude  I  quote  a  portion  of  his  own  letter:  'In  a  few 
months  my  hair  turned  from  black  to  white.  I  have 
often  experienced  a  regular  pain  in  my  brain,  quite 
different  from  the  neuralgia  from  which  I  sometimes 
suffer.  This  was  a  dull,  aching  pain,  an  uncomfortable 
sense  of  weight,  which  I  attributed  to  actual  cerebral 


142     Causation  and  Treatment,  Psychopathic  Diseases 

exhaustion.  The  culminating  symptom  was  insomnia, 
or  a  restless  sleep  in  which  I  uttered  such  groans  that 
my  wife  frequently  awakened  me  believing  that  I  was 
ill.  My  stomach  was  atonic,  all  trace  of  appetite  gone, 
and  sexual  desire  suppressed.' 

"I  begged  another  of  my  friends,  who  was  a  Minister 
for  several  years,  to  give  me  some  notes  on  the  state 
of  his  health  during  a  protracted  and  very  lively 
contest  which  he  had  to  carry  on  in  Parliament  in  the 
defence  of  one  of  his  bills.  Here  is  his  reply:  'My 
character  was  much  altered.  I  suffered  from  an 
extraordinary  degree  of  nervous  excitability.  Usually 
good-natured  and  affectionate  in  my  family  life,  I 
became  taciturn  and  extremely  irritable;  and  perhaps 
things  would  have  gone  from  bad  to  worse  had  not  my 
friends,  urged  thereto  by  my  family,  constrained  me 
to  leave  my  work  and  go  off  to  the  country.  I  was  get- 
ting no  good  from  my  food,  though  my  muscular  ener- 
gy had  not  decreased,  save  that  in  the  evening  I  felt 
as  if  I  could  not  move  from  my  seat.  My  sight  was 
much  affected,  and  I  suffered  from  sudden  nervous 
twitches.' 

"These  notes  are  of  the  more  importance  in  our 
study  of  the  effects  of  great  and  continuous  work,  in 
that  their  writer  is  a  man  of  great  capacity  and  energy 
who  attained  to  power  in  the  prime  of  life,  when  he 
was  already  inured  to  Parliamentary  contests. 

"For  other  evidence  regarding  overpressure  among 
politicians,  I  have  been  indebted  to  the  kindness  of 
some  of  my  colleagues,  who  have  tried  to  attend  patients 
of  this  class. 

"Affections  of  the  heart  and  neurasthenia  become 
very  common  among  those  members  who  take  part  in 
the  Parliamentary  debates.  I  shall  record  some 
facts  regarding  them  which  have  been  made  known  to 
me  by  their  physicians. 


Neuron  Energy  and  Neurosis  143 

"There  is  one  very  energetic  member  who  succumbs 
from  time  to  time  to  cerebral  fatigue,  and  is  forced  to 
call  in  medical  aid.  In  his  case  the  first  symptoms  are 
insomnia  and  headache,  but  these  are  not  sufficient 
to  arrest  him  in  the  rush  of  his  political  engagements. 
He  perceives  that  he  is  exhausted  only  when  at  the  end 
of  a  sitting  of  the  House  he  cannot  recall  what  has  been 
said  at  the  beginning.  He  is  then  terrified  and  dejected, 
because  he  finds  himself  out  of  the  fight.  Sleep  is  of 
little  use  to  him,  for  he  dreams  continually  of  the 
debates  and  of  political  affairs.  This  is  one  of  the 
most  serious  symptoms  of  cerebral  overstrain.  When 
our  day's  occupations  pursue  us  in  our  dreams  and  we 
feel  insufficiently  rested  in  the  morning,  there  is  no 
need  to  consult  a  doctor;  we  must  take  a  holiday  or 
greater  evils  will  follow. 

"Another  member,  after  having  undergone  great 
fatigue  at  the  House,  was  attacked  by  palpitation  at  an 
official  banquet  where  he  had  to  propose  a  toast,  and 
was  forced  to  limit  his  speech  to  a  few  words.  From 
that  day  he  had  frequent  attacks  of  palpitation,  and 
suffered  from  nausea  when  he  was  obliged  to  work 
at  his  desk.  He  was  troubled  with  insomnia,  and  had 
remarkable  fits  of  trembling  in  his  legs  and  hands, 
more  especially  when  he  appeared  in  public.  Some- 
times when  he  was  making  a  speech  this  trembling 
became  so  noticeable  that  he  had  to  sit  down.  The 
smallest  indiscretion  in  diet  was  followed  by  diarrhea 
lasting  for  two  or  three  days. 

"All  these  phenomena  are  the  more  characteristic  of 
overpressure  in  that  the  man  in  question  possessed  a 
good  constitution  with  no  unfavorable  hereditary 
predispositions,  and  always  enjoyed  good  health  before 
entering  political  life.  He  complained  to  his  medical 
adviser  that  he  had  become  irritable;  and  being 
naturally  of  a   good-natured   and   pacific  disposition, 


144     Causation  and  Treatment,  Psychopathic  Diseases 

he  felt  every  outburst  of  anger  as  a  profound  humilia- 
tion. " 

An  important  feature  in  the  symptom-complex 
of  psychopathic  diseases  is  the  fact  that  the  patients, 
after  fatigue,  feel  worse,  as  far  as  their  general  symptoms 
are  concerned,  more  depressed,  the  fears  come  to  the 
surface  with  great  intensity,  and  often  become 
uncontrollable.  In  cases  where  the  patient  gets 
control  over  his  fears,  the  onset  of  fatigue  brings 
about  the  recurrent  states  of  the  fear  instinct  in  their 
full  emotional  vigor.  A  patient,  a  physician,  writes 
to  me:  "The  prevailing  symptoms  are  dread,  fear  and 
anxiety  about  travel  and  being  away  from  home, 
mental  sluggishness,  quick  fatigue  and  inability  for 
concentrated  thought." 

Another  patient,  a  physician  of  a  good  deal  of  experi- 
ence, in  consulting  me  about  his  psychopathic  state  of 
fears  which  he  has  been  trying  to  control  for  a  couple 
of  years,  finds  that  the  fears  become  uncontrollable 
and  overwhelming  with  the  onset  of  fatigue.  When- 
ever he  gets  very  tired,  especially  when  working  in  the 
laboratory  and  the  clinic  for  many  hours  on  a  work 
that  has  to  be  completed,  he  finds  that  he  begins  to 
suffer  from  insomnia;  along  with  it  the  fears  rise  to 
the  surface  of  consciousness  with  an  intensity  that  is 
almost  horrifying. 

Later  on  this  state  of  fears,  this  arousal  of  the  fear 
instinct  begins  to  recur  more  and  more  easily,  the 
fatigue  state  keeps  on  recurring  with  greater  ease  and 
at  shorter  intervals.  The  patient  finds  that  fatigue, 
especially  emotional  and  intellectual,  requiring  con- 
centration of  attention,  and  worry  over  the  outcome 
of  the  work  invariably  bring  about  the  onset  or 
recurrence  of  the  fears  in  their  full  intensity.  The 
result  in  the  physician's  case  was  the  usual  one,  the 
patient  formed  an  intense  fear  of  fatigue,  a  fatigue-fear. 


Neuron  Energy  and  Neurosis  145 

Fatigue-fear  is  quite  common  with  psychopathic 
patients.  A  vicious  circle  is  formed.  The  fear  instinct 
by  its  continuous  action  and  arousal  of  the  wearisome 
and  exciting  emotion  of  fear  produces  fatigue,  and 
conversely  fatigue  helps  to  produce  a  more  intense 
condition  of  the  fear  instinct  and  the  impulse  of  self- 
preservation.  The  patient  is  afraid  that  overfatigue 
might  injure  him  and  might  give  rise  to  a  worse  state 
of  health  or  disease.  Finally  there  is  formed  the  fear 
of  doing  any  thing,  the  fear  of  fatigue,  the  searching 
after  composure  and  euphoria,  the  restless  hunting 
after  rest. 

In  the  treatment  of  psychopathic  diseases  the 
physician  must  take  this  condition  into  account.  A 
few  cases  will  best  bring  out  this  point  of  "fear  fatigue. " 

"My  early  fears  were  such  as  are  common  to  children. 
I  feared  the  dark  and  was  very  fearful  when  sleeping 
in  a  room  by  myself.  As  a  boy  I  was  very  timid  and 
bashful. 

"At  the  age  of  eight  to  twelve  I  remember  thinking 
that  my  mother  might  die.  My  mother  was  in  poor 
health  at  the  time,  having  suffered  a  nervous  breakdown 
at  the  death  of  my  father. 

"At  the  age  of  ten  or  twelve  there  came  into  my  life 
something  to  be  noted  perhaps  as  a  neurasthenic 
symptom.  At  this  time  I  gradually  became  possessed 
of  a  fear;  I  was  afraid  to  leave  home,  that  is,  to  get 
away  from  my  own  home  and  home  people.  This 
grew  upon  me  to  such  an  extent  as  to  make  life  very 
miserable,  for,  to  leave  home  and  home  people  even  for 
a  day,  I  thought  I  was  going  to  die.  I  would  become 
faint  and  turn  pale. 

"This  fear  kept  me  at  home  a  great  deal  during  this 
period,  for  I  would  not  leave  home  unless  accompanied 
by  some  of  my  people.  Finally  I  decided  to  conquer 
this  thing  or  die  in  the  attempt.     So  one  day  I  left 


1 46     Causation  and  Treatment j  Psychopathic  Diseases 

home  alone  to  attend  a  carnival  in  a  neighboring  town. 
This  fearful  dread  was  constantly  with  me  and  as  I 
would  think  about  it  I  would  become  weak  and  faint. 
Nervous  waves  of  apprehension  and  fear  would  pass 
over  me,  and  I  would  feel  as  if  I  were  sinking.  At  one 
time  during  the  day  I  became  very  faint,  turned  pale 
and  was  sick.  I  tried  to  drink  something  cold,  but 
this  made  me  more  sick.  I  found  a  place  to  sit  down 
and  this  spell  passed  off. 

"Having  conquered  this,  I  began  to  outgrow  this 
fear,  so  that  from  that  day  on  it  gradually  wore  away 
until  I  had  no  fear  whatsoever  of  leaving  home. 

"As  I  grew  out  of  the  boyhood  stage  into  my  'teens 
I  was  quite  ambitious  and  entered  rather  vigorously 
into  work  at  an  early  age.  I  worked  hard  on  the  farm 
during  the  summer  and  attended  school  during  the 
winter. 

"As  I  grew  out  of  the  'teens  I  came  to  have  periods 
of  great  mental  depression  and  that  often  without  any 
cause.  These  depressions,  beginning  at  about  the  age 
of  eighteen,  grew  upon  me  as  I  became  older.  At  length 
they  would  affect  me  so  as  to  incapacitate  me  for  work, 
and  while  under  this  mental  depression  would  be  able 
to  work  only  through  great  effort  of  will. 

"At  various  times  during  my  life,  some  matter  of 
minor  importance,  such  as  some  trouble  or  difficulty, 
would  become  fixed  upon  my  mind  and  I  would  seeming- 
ly be  unable  to  throw  it  off.  This  would  throw  me  in 
a  depression  and  I  would  feel  tired  out  and  without 
ambition  until  things  gradually  wore  off. 

"One  night  I  awoke  out  of  troubled  sleep  with  a 
fearful  start  and  thought  I  was  going  crazy.  The 
tortures  I  suffered  for  the  next  half  hour  are  well  nigh 
indescribable.  The  next  day  I  was  in  a  highly  nervous 
state  and  had  great  fears  that  I  would  go  insane.     This 


Neuron  Energy  and  Neurosis  147 

shock  finally  wore  off  somewhat,  and  I  did  not  consult 
a  physician  as  I  think  I  should  have  done. 

"  I  continued  with  my  college  work  as  I  was  attending 
college  at  this  time,  but  I  continued  to  suffer  the  tor- 
ments of  the  damned  and  had  constant  fears,  was  very 
much  depressed  and  always  tired  out. 

"This  was  about  Easter  time,  191 1  and  during  my 
Easter  vacation  I  took  a  trip  away  from  home,  hoping 
that  the  change  would  relieve  my  mind  of  the  fearful 
state  in  which  it  was  in.  I  came  back  none  the  better 
for  my  trip. 

"I  now  went  back  to  my  college  work  and  finished  the 
year  in  this  wretched  state.  Now,  with  vacation  on 
and  the  cause  of  my  trouble  entirely  removed,  I  thought 
I  should  improve,  but  instead  continued  to  remain  in 
this  miserable  state  of  mind,  extreme  lassitude,  and  a 
morbid  mental  depression  almost  all  the  time. 
Occasionally  my  spirits  would  rise  for  a  time  and  I 
would  think  I  was  improving,  but  this  was  only 
temporary  or  spasmodic  and  would  last  for  a  few  hours 
or  a  day  or  two,  when  I  would  again  sink  into  the  usual 
state  of  depression. 

"I  now  consulted  a  physician  who  said  I  had  had  a 
nervous  breakdown  and  that  with  proper  rest  I  would 
regain  my  strength  and  be  well  again  as  usual. 

"Upon  this  advice  I  remained  at  home  during  the 
summer,  doing  only  what  I  wanted  to  about  the  house. 
I  did  not  gain,  however,  during  the  summer. 

"During  the  summer  I  was  out  camping  for  a  week, 
where,  under  the  influence  of  congenial  young  people, 
I  lost  sight  of  my  troubles  and  gained  wonderfully  both 
in  strength  of  mind  and  body.  This  improvement 
took  place  within  one  week  and  at  the  end  of  that  time 
I  went  home  a  new  man. 

"In  September,  191 1, 1  went  to  southwestern  Virginia 
where  I  had  the  promise  of  work  and  where  I  thought 


148     Causation  and   Treatment^  Psychopathic  Diseases 

the  change  would  improve  my  condition.  In  October, 
191 1,  I  began  work  with  the  C.  C.  Co.,  Bristol,  Va., 
but  soon  found  myself  so  incompetent  to  do  the  work, 
and  the  work  caused  such  a  strain  and  suffering  on  my 
part  that  I  dropped  it  for  a  time,  and,  after  consulting 
a  local  physician,  went  up  into  the  mountains  of  East 
Tennessee.  Here  I  spent  ten  days  or  two  weeks  tramp- 
ing around  the  mountains  and  eating  heartily.  The 
change  of  environment  and  climate  seemed  to  work  no 
improvement  in  my  condition. 

"I  came  back  to  Bristol  and  took  up  my  work  again, 
but  had  to  give  it  up  soon,  because  of  the  fearful  strain 
under  which  I  worked.  However,  as  I  did  not  gain  at 
all  during  the  period  of  idleness  I  resolved  to  go  to  work 
again  if  it  killed  me.  So  I  went  to  work  on  December 
II,  and  continued  until  August,  191 2. 

"  In  December  I  began  treatment  with  an  osteopathic 
physician  and  continued  for  four  months.  He  did 
nothing  for  me  whatsoever,  but  take  my  money. 

"During  the  eight  months  I  was  working,  I  observed 
every  possible  chance  for  my  improvement,  took 
physical  culture  exercises,  cold  plunge  every  morning, 
studied  my  diet  till  I  was  relieved  of  constipation,  but 
in  spite  of  all  this  I  gradually  lost  flesh  until  by  Aug- 
ust I,  I  had  lost  twenty  pounds  and  was  so  weak  at 
times  that  I  could  hardly  move. 

"I  was  returning  to  my  home  in  Vermont  in  August, 
to  recuperate,  and  I  stopped  in  Washington,  D.  C,  to 
consult  Dr.  W.  He  advised  me  to  return  home  and 
spend  six  weeks  in  recuperating,  and  if  at  the  end  of 
that  time  I  was  not  improved  I  could  return  to  him  for 
treatment,  or  he  would  refer  me  to  some  one  in  New 
England,  or  Boston. 

"Following  Dr.  W.'s  advice  I  returned  home  and 
availed  myself  of  every  possible  opportunity  to  have 
a  good  time.     But  at  no  time  did  I  have  a  rise  of  spirits 


Neuron  Energy  and  Neurosis  149 

or  any  feeling  of  well-being  whatsoever.  I  began  to 
eat  well  and  sleep  well,  but  there  was  no  change  in  the 
condition  of  mental  depression  or  extreme  lassitude. 
My  strength  and  weight  increased  somewhat,  but  not 
enough  to  make  any  perceptible  difference. 

"On  October  4,  I  began  treatment  with  Dr.  Sidis. 
For  the  first  four  days  I  did  not  improve  at  all;  in  fact, 
I  was  more  despondent  than  usual  and  very  nervous 
at  times,  which  was  the  result  of  the  change  in  conditions 
and  certain  anxieties  and  fears  which  the  new  under- 
taking caused  me. 

"On  the  1 8th,  there  was  a  marked  improvement 
in  my  condition.  I  rose  with  the  usual  depression, 
took  a  cold  plunge,  went  outdoors,  and,  as  I  was  walking 
about  the  house,  began  to  feel  better.  This  good  feeling 
came  on  quite  rapidly  and  continued  throughout  the 
day.  This  improvement  seemed  to  be  principally 
in  the  mental  condition,  an  uplifting  of  the  great  de- 
pression, freedom  from  cares  and  anxieties,  and  also 
a  general  return  of  strength  and  powers.  This  im- 
provement was  general  throughout  the  week.  During 
this  week  I  felt  very  much  improved  and  would  talk 
freely  with  the  boys,  and  the  world  began  to  look  dif- 
ferent to  me.  However,  I  was  not  confident  that  this 
condition  was  permanent,  I  feared  that  I  might  go 
back  at  any  time.  I  would  be  very  tired  when  night 
came,  but  without  the  usual  depression.  At  times  as 
I  was  thinking  about  myself  it  would  seem  as  if  I  would 
relapse  at  once  into  the  former  condition,  and  only  by 
great  will-power  could  I  throw  this  off  and  stop  thinking 
about  it  until  this  feeling  would  pass  away.  As  the 
week  passed  I  outgrew  these  fears  of  a  sudden  relapse, 
and  it  seemed  as  if  the  improvement  had  come  to  be 
permanent. 

"The  cure  began  to  go  down  slowly  and  gradually; 
and  without  any  cause  that  I  can  ascribe  to,  I  lost  hold 


150     Causation  and   Treatment,  Psychopathic   Diseases 

of  the  improvement  I  had  gained.  That  is,  by  degrees 
I  returned  to  the  lowered  condition  in  which  I  was  pre- 
vious to  October  18.  I  had  fully  relapsed  to  the  condi- 
tion in  which  I  could  not  seem  to  go  lower." 

After  six  months'  of  hypnoidal  treatment,  disintegra- 
tion of  fear  system,  well  balanced  and  careful  control  of 
work  and  rest  and  nutrition,  the  patient  gained  forty- 
live  pounds,  and  returned  home  well;  has  stayed  well 
for  three  years  and  is  doing  work. 

"My  earliest  recollection,"  one  of  my  patients  writes 
in  a  final  account,  "of  having  any  mental  or  nervous 
trouble  begins  at  fourteen.  Primary  cause  of  disease 
(if  cause  be  mental)  became  operative  at  twelve,  for 
then  I  learned  of  the  habit  of  masturbation  but  was 
deterred  from  indulging  at  first  except  very  infrequently, 
by  a  terrifying  idea  that  it  was  not  right,  and  a  few 
months  later  by  reading  a  booklet  about  electric  belts 
telling  of  the  terrible  effects  of  the  habit  on  the  mind 
and  the  nervous  system.  1  began  to  do  a  man's  work  at 
twelve,  was  large  for  my  age,  so  the  thirteen  or  fourteen 
hours  of  work  a  day  might  have  done  me  harm. 
Was  practically  full-grown  at  sixteen.  At  fourteen  the 
habit  of  self-abuse  got  firm  hold  on  me.  Practiced 
vice  almost  every  other  day.  Fear  of  harmful  results 
undiminished,  but  a  foolish  idea  that  through  preventing 
loss  of  semen  (i.e.,  I  thought  it  was  prevented)  by 
pressure  on  the  urethra  would  make  habit  almost 
harmless.  This  idea  let  the  habit  get  strongly  fixed. 
Ignorance  of  physiology  self-evident.  Practiced  habit 
till  sixteen,  at  same  time,  almost  daily,  read  advertise- 
ments in  newspapers  by  quack  specialists  for  'Diseases 
of  Men '  which  gave  various  symptoms  of  lost  manhood 
resulting  from  masturbation  and  other  causes. 

"Among  the  symptoms  which  impressed  themselves 
strongly  on  my  mind  and  which  I  thought  I  had  and 
were  being  caused  by  my  habit  were:  lack  of  energy, 


Neuron  Energy  and  Neurosis  151 

loss  of  memory,  lack  of  self-confidence,  fatigue, 
inability  to  concentrate  mind,  weakness  and  lassitude, 
and  a  long  train  of  similar  ones.  At  the  end  of 
fifteenth  year  during  a  hot  and  strenuous  harvest  at 
driving  a  binder,  and  immediately  afterwards,  distinctly 
remember  being  very  cross,  irritable,  tired,  and  easily 
depressed,  and  then  occurred  on  one  occasion  what 
seemed  a  strange  loss  of  memory:  I  could  not  remember 
the  names  of  three  of  our  hired  men  after  an  absence 
of  a  month.  Shortly  after  I  became  sixteen,  I  became 
so  convinced  of  and  frightened  by  the  harm  I  thought 
masturbation  was  doing  me  that  I  broke  it  off  abruptly, 
and  practiced  it  only  at  long  intervals  of  several  months. 
I  thought  I  had  done  myself  great  harm.  My  mind 
seemed  to  be  in  particularly  bad  condition  and  I  felt 
a  lack  of  energy  physically.  My  mental  weakness 
and  physical  condition  caused  me  so  much  alarm  that 
I  wrote  to  a  quack  specialist  for  diseases  of  men.  He 
answered  that  I  had  nervousness,  sexual  weakness, 
lack  of  erectile  power  (I  thought  this  symptom  partic- 
ularly indicative  of  great  harm),  weak  kidneys,  etc. 
Had  no  money  so  could  not  take  his  treatment.  His 
letter  gave  me  the  first  impression  that  I  was  nervous. 
Prior  to  that  I  had  no  definite  idea  of  the  nature  of  my 
disease  and  even  then  didn't  know  what  nervousness 
meant  and  didn't  associate  it  with  exhaustion,  although 
I  really  was  easily  fatigued.  In  my  first  letter  to  the 
quack  I  wrote  that  I  had  syphilis,  thinking  that  because 
my  hair  was  falling  out  badly  I  had  that  disease,  so 
great  was  my  ignorance. 

"About  this  time  I  bought  an  old  family  doctor 
book  which  told  of  the  terrible  effects  of  self-abuse,  and 
that  nervousness  was  almost  incurable.  At  about  the 
middle  of  the  sixteenth  year  I  thought  I  had  been  seen 
in  the  act  of  masturbating  (I  probably  was  seen)  by 
one  of  our  hired  men.  Believing  he  would  tell  the  whole 


152     Causation  and  Treatment,  Psychopathic  Diseases 

neighborhood  about  it,  I  was  seized  with  a  profound 
spell  of  mental  depression.  I  overpowered  the  fellow 
one  night  (he  was  not  big  and  I,  even  at  sixteen,  was 
over  six  feet  tall  and  quite  muscular)  threatened  his 
life,  but  he  denied  telling  or  knowing  about  my  habit. 
Swore  him  to  secrecy.  Some  of  his  acquaintances 
would  look  at  me  with  a  queer  smile  and  I  was  quite 
certain  that  he  told. 

"For  several  months  afterwards  I  was  troubled  with 
profound  mental  depression  and  weakness.  After  I 
became  seventeen,  I  decided  to  go  to  a  normal  school 
in  a  neighboring  town.  I  graduated  from  common 
school  at  fifteen,  but  had  to  work  the  next  winter. 
Father  took  me  to  the  normal  school,  arranged  every- 
thing, and  then  left  me  there  alone.  The  idea  of  going 
to  school  gave  me  much  pleasure,  but  this  with  the 
unusual  sights  and  sounds  I  had  seen  and  heard  during 
the  day  (the  town  was  a  much  larger  one  than  I  had 
ever  been  in  before)  had  the  effect  of  so  exciting  me 
that  I  could  not  sleep  that  night.  I  went  to  school  the 
next  day  not  worried  about  this  loss  of  sleep  and 
was  enrolled  in  all  my  classes.  Tried  to  study  in  the 
evening,  but  found  my  mind  confused,  my  memory 
bad,  and  my  old  depression  was  still  there. 

"I  was  unable  to  sleep  the  next  two  nights  so  I  went 
home  and  consulted  a  physician.  Told  him  I  had 
insomnia.  The  physician  said  my  trouble  was  mental, 
but  I  could  not  understand  or  believe  it.  I  went  to 
school  for  a  week,  but  complete  insomnia  drove  me 
home.  The  physician,  on  my  first  visit,  said  I  had 
been  reading  a  whole  lot  of  quack  literature  on  sexual 
matters  and  that  that  had  done  me  harm.  Partial 
insomnia  followed  for  two  months  and  then  restful 
sleep  came  with  the  use  of  a  new  compound  of  drugs. 
With  the  use  of  an  electric  belt  and  the  hard  spring 
work  the  insomnia  disappeared  the  next  month. 


Neuron  Energy  and  Neurosis  153 

"In  the  fall  when  hard  work  was  over  the  fear  that 
the  insomnia  would  return  took  hold  of  me.  The 
insomnia  did  return,  and  the  strongest  sedatives  that 
two  different  physicians  could  give  me  failed  to  make  me 
sleep  for  three  weeks.  Both  physicians  said  the  trouble 
was  mental,  and  I  was  now  told  that  drugs  would  do 
me  no  good.  I  resigned  myself  to  death  or  insanity. 
I  took  to  religion,  stopped  worrying,  and  sleep  came  in 
a  week.  My  physician  told  me  again  and  again  that 
the  trouble  was  mental,  but  I  thought  it  was  from  a 
shattered  nervous  system  caused  by  self-abuse.  The 
insomnia  was  much  less  severe  during  the  late  fall  and 
winter  of  my  eighteenth  year.  During  most  of  my 
nineteenth  year  could  only  sleep  six  and  a  half  or  seven 
hours  in  spite  of  hard  work.  This  worried  me  and  I 
felt  exhausted  and  feared  that  my  health  was  being 
ruined. 

"All  these  years,  whether  I  had  slept  well  or  not,  I 
still  had  the  same  old  physical  fatigue,  melancholia, 
and  mental  weakness.  At  eighteen  began  to  read  New 
Thought  literature  and  to  get  vague  ideas  of  the  sub- 
conscious mind,  suggestion,  psychotherapeutics;  with 
them  came  more  of  a  belief  in  mental  methods,  but  still 
the  idea  haunted  me  that  self-abuse  had  caused  my 
condition.  When  nearly  twenty,  decided  to  take  mental 
treatment  from  a  pretended  authority  in  psycho- 
therapeutics at  Chicago.  He  wanted  to  give  me 
'absent  treatment.'  The  local  physician  advised  me 
against  it  and  told  me  to  go  to  school  and  to  mix 
with  the  young  people  as  much  as  possible.  I  went  to 
school,  only  took  two  or  three  subjects,  and  though  I 
slept  six  or  seven  hours  (often  more),  thought  I  had 
insomnia,  worried  about  it,  felt  terribly  weak,  mentally 
and  physically,  went  home  at  end  of  term  thoroughly 
exhausted,  so  I  thought  and  felt.  During  these  last 
two  years  read  a  great  deal  of  drugless  healing  and 


154     Causation  and   Treatment^  Psychopathic  Diseases 

physical  culture  literature,  thus  formed  a  strong 
prejudice  against  drugs  and  a  firm  belief  in  the  so-called 
natural  methods  of  healing.  The  last-mentioned 
physician  had  also  said  my  disease  was  mental.  How- 
ever, I  didn't  think  he  knew  anything  about  psycho- 
therapy. I  now  wrote  to  the  (to  me  eminent)  psycho- 
therapist of  Chicago.  He  answered  that  I  was  a 
neurasthenic  of  the  truest  type. 

"  I  began  to  sleep  better  immediately,  thought  him  a 
great  authority,  and  tried  to  follow  his  advice  to  the 
letter.  Followed  his  advice  very  closely  in  spite  of 
many  ups  and  downs,  much  more  faithfully  than  I 
ever  followed  yours,  shameful  as  it  is  to  admit  it.  I 
still  had  all  my  old  symptoms,  except  that  of  insomnia. 
I  got  discouraged  with  him  and  quit  him.  I  ought 
to  mention  here  that  since  I  was  thirteen  I  never  had  a 
friend  and  never  went  visiting,  except  to  a  few  dances 
which  I  did  by  the  advice  of  my  quack  doctor  who 
tried  to  get  me  to  cultivate  my  social  faculties.  I  was 
discouraged  for  about  a  month,  then  got  new  faith  in 
the  regime  I  had  been  following,  added  some  nature 
cure  and  New  Thought  ideas  to  it  and  still  hoped  for 
success. 

"I  went  to  school^  the  following  winter  with  the 
resolution  to  succeed  or  die.  Slept  little  the  first  week, 
but  for  the  four  following  months  slept  well  in  spite  of 
considerable  study.  Study,  I  used  to  think,  would 
cure  insomnia.  In  the  fourth  month  of  my  stay  at 
school,  I  took  two  extra  subjects  and  cut  my  sleep  to 
seven  hours.  I  was  obliged  to  study  unusually  hard 
to  get  my  work  done.  I  had  always  had  spells  of 
depression  without  apparent  cause,  but  during  this 
fourth  month  a  sense  of  exhaustion  gradually  developed 
in  me,  and  I  seemed  to  be  losing  ground  in  my  studies. 
After  a  month  and  a  half  of  this  new  regime  insomnia 
came  on,  from  fatigue  and  seemingly  not  at  all  from 


Neuron  Energy  and  Neurosis  1 55 

anxiety  about  sleep.  I  was  soon  completely  prostrated 
by  fatigue  and  insomnia  (the  insomnia  now  becoming 
formidable  again:  five  or  six  hours  of  sleep)  so  that  I 
couldn't  study,  managed  to  stay  till  end  of  term,  a 
period  of  a  month  and  a  half  in  this  condition.  I 
consulted  Dr.  A.,  who  said  that  my  trouble  was  prob- 
ably physical,  and  that  I  needed  a  great  deal  of  sleep. 

"I  had  put  my  whole  heart  and  soul  into  psycho- 
therapeutic methods  of  cure  for  nearly  two  years  and 
it  had  apparently  ended  in  complete  failure.  Dr. 
A's  opinion  that  my  disease  was  physical  settled  the 
matter  in  my  mind.  I  was  convinced  I  needed  rest, 
sleep,  and  proper  nourishment.  Dr.  Mitchell's  'rest 
cure'  was  what  appealed  to  me,  but  Dr.  A.,  would  have 
me  go  to  Boston  and  consult  nerve  specialists.  I 
went  to  Boston,  consulted  Dr.  P.,  who  questioned 
me,  tried  my  reflexes,  and  said  I  had  a  strong  physique 
and  a  'great  heart.'  He  said  my  disease  was  caused 
by  subconscious  ideas,  and  that  I  had  to  work,  because 
people  in  my  condition  always  get  worse  with  rest.  He 
sent  me  to  you.  I  feared  that  Dr.  P.  and  you  had  told 
me  my  disease  was  mental  just  for  suggestive  effect, 
and  that  my  disease  might  be  physical  to  a  considerable 
extent. 

"Came  to  Boston  and  went  to  work.  The  work 
was  not  hard,  but  the  fatigue  was  terrible  and  by  the 
end  of  the  sixth  month  seemed  to  have  grown  un- 
bearable. In  the  evenings  after  work  it  was  so 
great  I  couldn't  talk. 

"The  idea  that  'rest  cure'  might  have  been  better  for 
me  was  in  my  mind  at  your  Institute  and  also  during 
the  first  six  months  in  Boston. 

"Sleep  came  a  week  later.  Highly  enthusiastic  about 
this  achievement.  Resolved  to  go  to  school.  Fatigue 
disappeared  for  several  weeks  during  period  of  elation. 
Should  say  that  the  above  work  was  first  I  had  done 


156     Causation  and    Treatment^  Psychopathic  Diseases 

away  from  home,  and  was  naturally  worried  under  a 
very  cross  employer.  I  consulted  you  again,  you 
advised  me  to  go  to  school.  I  went  to  school  about  a 
month  without  dropping  my  other  work  (I  took  only 
two  subjects),  but  at  the  end  of  that  period  I  had  to 
drop  manual  labor  from  overpowering  sense  of  mental 
weakness  and  physical  fatigue.  I  got  through  first 
term  with  much  difficulty.  By  this  time  I  began  to 
make  friends.  I  got  through  second  term  with  less 
difficulty  and  more  social  experience.  At  beginning 
of  third  term  I  got  insomnia  from  a  fatigue  which  had 
been  gradually  growing  to  a  terrifying  degree. 

"Two  visits  to  you  at  Portsmouth  made  me 
feel  highly  elated  for  about  two  months.  My  fears 
and  worries  may  be  reduced  to  one,  and  that  is 
^Fatigue.*  I  am  not  worried  about  sleep  at  present, 
but  there  is  still  the  haunting  idea  that  hard  study  with 
little  physical  exercise  would  cause  it.  I  am  mentally 
and  physically  fatigued  most  of  the  time  and  yet  the 
amount  of  work  I  do  is  ridiculously  small.  I  don't 
accompHsh  anything  and  don't  see  how  I  can  ever  make 
a  living,  if  I  don't  get  rid  of  the  fatigue.  Depression 
accompanies  the  fatigue,  if  the  latter  is  at  all  severe, 
and  makes  everything  look  black.  Your  statement 
at  my  last  visit  that  my  fatigue  was  caused  by  my  fear 
of  it  and  constantly  thinking  of  it,  struck  me  with 
great  force.  It  seems  so  very  reasonable,  and  appeals 
to  me  so  strongly  that  it  bids  fair  to  do  me  great  good. 
After  re-reading  this  whole  account  my  disease  seems 
to  be  a  ridiculous  matter  made  up  of  stupidity  and 
foolish  fears." 

F.  E.  C,  Female,  unmarried,  forty-three  years  old. 

"I  have  practiced  in  P.  for  a  few  years.  Previously 
a  teacher. 

"I  have  had  no  Illnesses,  except  several  attacks  of 
intestinal    impaction.     There    is    no    organic    trouble. 


Neuron  Energy  and  Neurosis  157 

"Life  has  been  active  and  full  of  interests,  with  more 
duties  and  pleasure  than  I  had  time  for.  The  only 
discomfort  I  have  had  was  a  weariness.  I  enjoy  work 
and  have  taken  a  keen  interest  in  life  until  lately,  when 
I  developed  a  distaste  for  everything. 

"The  physical  symptoms  began  in  the  summer  of 
191 2.  I  was  very  tired,  but  took  no  vacation  except 
week-end  trips  at  the  beach  from  Friday  to  Monday. 
I  noticed  it  was  difficult  to  carry  a  light  suit-case;  no 
grip  in  hands  or  strength  in  arms.  One  day  I  hurried 
to  catch  a  street-car  and  started  to  step  on.  My  legs 
seemed  to  give  away  and  I  fell,  striking  my  head  on 
the  pavement.  Since  then,  at  times,  I  have  had  a  fear 
of  getting  on  cars,  and  for  many  months  before  I  stopped 
work,  only  a  resolute  determination  not  to  give  way  to 
fear  kept  me  using  the  public  vehicles.  I  could  not 
lift  my  foot  to  the  first  step,  or,  having  accomplished 
that,  I  could  not  pull  myself  up  without  help.  The 
moment  I  tried  to  step  up  I  became  a  dead-weight. 

"You  will  understand  that  I  can  give  you  no  adequate 
description  of  the  distress  and  humiliation  I  suffered. 
I  lived  in  dread  of  the  hour  coming  when  I  had  to  get 
on  a  car,  or  into  an  auto  to  go  home  from  the  office.  I 
thought  it  was  a  mental  state  that  I  should  not  yield 
to,  and  so  I  kept  up  the  fight  till  May,  1914. 

''During  the  winter  of  191 3-14  I  realized  that  my 
work  was  deteriorating;  my  fingers  and  wrist  lacked 
power  to  do  the  mechanical  part  of  my  work,  but, 
worse  than  that,  my  mind  was  acting  mechanically; 
I  lacked  enthusiasm  and  I  was  tired  all  the  time,  but 
as  great  fatigue  was  a  condition  that  had  been  present 
most  of  my  adult  life,  I  paid  no  attention  to  it.  This 
seemed  a  condition  of  deadness;  there  was  nothing  I 
wanted  to  do,  nowhere  I  wanted  to  go,  and  no  one  I 
wanted  to  see. 

"  If  I  had  had  a  desire  for  anything  but  work  1  think 


158     Causation  and   Treatment,  Psychopathic  Diseases 

I  should  have  taken  a  vacation  sooner.  In  May  I 
decided  to  leave  the  office  for  the  summer.  Just  then 
I  took  a  severe  cold — "grippy" — which  prostrated  me. 
My  left  eyelid  drooped,  and  I  lost  control  of  it  and  of 
my  throat  and  tongue.  My  voice  sounded,  as  if  my 
mouth  were  full,  and  I  had  great  difficulty  in  swallowing. 
These  symptoms  disappear  for  a  time,  but  return  with 
the  least  over-exertion  or  strain.  The  last  six  weeks 
they  have  been  acute. 

"As  soon  as  I  was  able  to  travel  I  went  to  the  beach 
for  six  weeks  alone  among  strangers.  I  had  trouble 
in  dressing  myself,  cutting  meat,  and  in  all  the  little 
finger  and  wrist  movements,  but  I  improved  in  health 
and  prided  myself  on  my  ability  to  get  on  a  car  without 
help  when  I  came  home.  I  returned,  because  my  sister 
was  very  ill.  It  was  weeks  before  she  felt  sure  she 
would  live,  and  the  strain  of  that  time  was  too  great 
for  me. 

"I  felt  unnerved  and  unequal  to  business  or  social 
life.  The  only  thing  I  seemed  to  want  was  cold  weather. 
I  felt  so  utterly  tired  of  the  monotony  of  life  in  C. 

"In  November, mother  and  I  came  to  a  farm  in  N. 
to  spend  the  winter  with  my  sister  and  her  family. 
The  trip  was  wearing,  and  I  stayed  in  bed  for  a  month 
after  reaching  here.  I  was  benefited  by  the  rest,  and 
enjoyed  the  crisp,  cold  air  that  poured  down  across  the 
bed  from  two  open  windows. 

"The  winter  has  been  severe — fifty-seven  inches  of 
snow — and  it  has  kept  me  in.  I  like  cold  and  I  wanted 
to  get  out,  but  when  I  tried  to  walk  on  the  shovelled 
paths  in  the  snow,  I  found  myself  unexpectedly  sitting 
in  a  snowbank  with  no  ability  to  get  up,  and  no  knowl- 
edge of  why  I  should  have  fallen.  I  seemed  paralyzed 
by  the  cold.  February,  March,  and  April  have  been 
raw,  gloomy,  depressing  months,  and  I  have  failed 
steadily  in  flesh,  strength,  and  control. 


Neuron  Energy  and  Neurosis  159 

"My  legs  act  like  wooden  pegs,  and  I  am  not  always 
sure  of  crossing  a  room  without  giving  way.  My  jaw 
won't  work  well  enough  to  masticate  solid  food.  Some 
times  my  neck  feels  as  if  it  would  break  like  a  brittle 
stick,  if  I  tried  to  make  it  hold  my  head  longer.  Throat 
won't  swallow,  eyes  won't  focus  alike,  eyelid  droops, 
arm  can't  lift  a  spoon  to  my  mouth  at  times.  All  these 
symptoms  disappear,  if  I  take  a  spoonful  of  brandy. 

"My  temperature  is  subnormal,  about  95  in  morning, 
and  my  pulse  can  hardly  be  felt.  Reflexes  normal, 
perhaps  slightly  exaggerated.  Muscles  atonic.  I  sleep 
well,  sometimes  without  waking  for  nine  hours. 

"I  feel  full  of  ambition  and  plans  while  I  am  lying 
down,  but  I  'wobble,'  and  terror  fills  my  soul  when  I 
have  to  stand,  or  walk,  or  meet  new  people,  and 
particularly  take  a  step  up  or  down. 

"Menstruation  has  always  been  regular,  normal, 
and  free,  until  and  including  February  20,  191 5.  I 
have  not  menstruated  since.  I  am  told  that  the  pelvic 
organs  are  normal,  no  enlargement,  and  no  atrophy. 

"My  lung  capacity  is  great,  my  digestion  fairly  good, 
constipation  Is  habitual.  No  pain,  except  neuralgic 
twinges. 

"If  I  take  strychnia  in  i-ioo  gr.  doses  three  times  a 
day  and  brandy  before  meals,  I  manage  to  eat  and 
walk,  but  depending  on  stimulants  does  not  seem  to 
me  to  be  good  practice.  I  have  had  that  treatment 
this  last  week  only. 

"While  at  the  beach  for  a  month  I  recorded  my 
dreams  as  carefully  and  accurately  as  I  could.  With 
that  as  a  basis  I  submitted  to  an  exhaustive  quizzing 
over  all  my  past  life.  No  experience,  no  emotion  of 
any  kind,  no  conscious  desire  was  concealed,  but  the 
cause  of  this  condition  was  not  revealed  as  far  as  the 
physician  could  determine. 

"For  the  last  five  years  I  have   lived  under  great 


i6o     Causation  and  Treatment^  Psychopathic  Diseases 

strain.  Added  to  the  pressure  of  financial  difficulties, 
was  the  strain  of  much  sickness  in  the  family.  My 
mother  twice  had  slight  cerebral  hemorrhages,  an 
invalid  sister  with  a  slow-growing  cancer  of  abdomen 
caused  me  much  anxiety  and  distress.  There  was  also 
a  case  of  tuberculosis,  and  it  seemed  that  I  was  never 
free  from  care  of  the  sick, — never  any  relaxation  at 
home. 

"I  have  given  you  as  complete  a  history  as  I  know 
myself.  I  am  weary  of  carrying  the  responsibility  of 
the  care  of  myself,  I  should  be  glad  to  be  told  what 
to    do,  and  made  to  do  it. " 

The  cases  and  accounts  cited  bring  out  clearly  the 
relation  of  fatigue,  fear,  and  psychopathic  states. 

Mosso  studied  the  state  of  professors  and  lecturers 
shortly  before  and  after  the  delivery  of  lectures.  He 
found  that  there  was  excitement  which  was  betrayed 
in  the  curves  of  the  ergograph,  the  sphygmograph,  and 
the  curve  of  blood  pressure.  "The  bladder  and  the 
intestine  betrayed  the  internal  agitation;"  Mosso 
might  have  added  glandular  secretions  as  shown  by 
Pavlow  and  his  school.  More  hormones  from  thyroid, 
parathoroid,  from  suprarenal  and  other  glands  and 
organs,  associated  with  emotions,  especially  with  that 
of  fear  are,  with  various  chemical  modifications  of 
functions,  discharged  into  the  blood,  and  brought  to 
various  organs  thus  effecting  serious  changes  of 
function. 

"Dr.  Salvioli"  Mosso  goes  on  to  say  "told  me  that 
his  appetite  before  lecturing  was  not  as  good  as  usual. 
I  have  seen  very  able  orators,  famous  professors,  find 
themselves  upset  at  the  prospect  of  reading  a  printed 
discourse.  I  remember  an  electoral  banquet  at  which 
one  of  the  best  known  deputies  in  the  Italian  Chamber 
neither  ate  nor  drank  till  he  had  run  through  the  speech 
which  he  was  to  read  to  his  electors,  and  of  which  he 


Neuron  Energy  and  Neurosis  l6l 

had  the  proof  in  his  pocket;  and  I  was  told  that  such 
was  always  his  custom.  With  all  the  admiration  I 
feel  for  the  courage  with  which  he  beards  his  opponents 
in  the  Chamber,  I  cannot  help  smiling  when  I  read 
the  reports  of  his  fiery  interruptions  and  recall  the 
fear  which  he  experiences  in  presence  of  the  electors." 

Here  too  it  is  the  intensity  of  the  impulse  of  self- 
preservation  with  fear  of  failure  that  has  brought  about 
the  temporary  state  of  psychopathic  affection.  The 
overwhelming  power  of  the  herd,  of  the  community, 
the  overpowering  sense  of  social  force,  and  the  loss  of 
individuality  in  the  mob  are  especially  conducive  to 
the  awakening  of  the  fear  instinct  and  to  the  arousal  of 
the  impulse  of  self-pri»ervation.  Social  disapprobation 
terrorizes  gregarious  'aan.  There  is  no  fear  greater 
than  social  panic.  I  pointed  this  out  in  my  work  on 
social  psychology  in  studying  the  action  of  the  mob  on 
the  consciousness  of  gregarious  man.  A  good  number 
of  the  fears  presented  in  psychopathic  cases  are  often 
of  a  social,  gregarious  character. 

No  instinct  works  with  such  fatal  effects  as  does  the 
fear  instinct  among  social  animals.  In  a  herd,  in  a 
crowd,  in  a  mob  the  fear  instinct  produces  the  most 
dangerous  results.  Invaj  ^^ Psychology  of  Suggestion" 
I  established  the  important  law  that  it  is  the  uncritical, 
subconscious  self  or  subconsciousness  that  is  subject 
to  suggestions  with  consequent  fatal  impulsive  actions. 
The  law,  as  supplementary  to  and  corollary  of  the  first 
law,  is  that  impulsive,  reflex  actions  are  controlled  by 
the  critical,  personal  self.  Another  important  law  es- 
tablished by  me  in  the  same  work  is  that  the  emotional 
excitement  of  a  social  aggregate  grows  in  a  geometrical 
-progression.  Professor  Giddings  in  discussing  the  laws 
of  social  action  adopts  these  laws.  "There  are  three 
of  these  laws"  he  says  "that  may  be  regarded  as 
demonstrated:    Impulsive  social  action  is  commenced 


1 62     Causation  and  Treatment,  Psychopathic  Diseases 

by  those  elements  of  the  population  that  are  least 
self-controlled.  .  .  .  The  law  of  the  extent  and 
intensity  of  impulsive  social  action  is  as  follow: 
Impulsive  social  action  tends  to  extend  and  to  in- 
tensify in  geometrical  progression.  .  .  .  The  law 
of  restraint  of  impulsive  social  action  is:  Impulsive 
social  action  varies  with  the  habit  of  attaining  ends 
by  indirect  or  complex  means,"  or,  truer  to  say,  by 
rational  means,  free  from  emotional  excitement.  No 
emotion,  however,  plays  such  havoc  as  the  emotion 
of  fear  instinct,  which  is  specially  subject  to  the 
second  law  of  geometrical  progression.  The  awakening 
of  the  fear  instinct  in  a  social  aggregate  is  overwhelming, 
irresistible  in  its  effects.  At  "^^e  basis  of  many  a 
pathological  phenomenon,  soci'l  and  individual,  we 
find  the  primitive  ruling  instinct  of  all  life,  the  impulse 
of  self-preservation  with  its  accompanying  fear  instinct. 


CHAPTER  XIII 

CLINICAL    CASES 

THE  fear  instinct  may  become  associated  with 
any  of  the  bodily  functions,  e.g.,  with  the 
sexual  instinct,  and  may  give  rise  to  subcon- 
scious states  characterized  by  an  abnormally 
developed  suggestibility.  These  conditions  may  in 
turn  give  rise  to  somopsychosis  and  psychoneurosis, 
according  to  the  temperament,  the  training,  and  the 
critical,  final  event  that  forms  the  last  link  in  the  pro- 
duction of  definite  psychopathic  symptoms.  In  all 
such  cases  it  is  not  the  particular  organic  function, 
whether  sexual  or  other,  that  produces  the  psycho- 
pathic state;  it  is  essentially  the  awakening  of  the 
most  powerful  and  least  controllable  of  all  animal 
instincts, — the  fear  instinct,  associated  with  the  sense 
of  the  mysterious.  Psychopathic  maladies  do  not 
depend  on  the  abnormal  functioning  of  some  one  bodily 
organ  or  function,  but  on  a  general  reaction  common 
to  all  bodily  and  mental  functions,  viz.,  the  fundamen- 
tal primitive  fear  instinct  which  relates  to  life  in 
general.  The  deranged  functions,  cardiac,  respiratory, 
circulatory,  intestinal,  glandular,  or  sexual,  fatigue,  con- 
flict, shock,  are  only  the  occasions.  To  regard  any  of 
these  occasions  as  the  source  of  psychopathic  maladies 
is  like  regarding  the  weathercock  as  the  cause  of  the 
wind.  The  fear  instinct,  rooted  in  the  impulse  of  self- 
preservation,  is  the  source  of  all  psychopathic  maladies. 
I  shall  adduce  here  a  few  cases  which  may  be  taken 
as  fair  examples  of  psychopathic  cases  in  general: — 

N.  R.  Russian.  Student.  Age  nineteen.  Family 
history  good.  Patient  complains  of  heart  trouble. 
He  has  pains  around  the  cardiac  region,  suffers  from 

163 


164     Causation  and  Treatment^  Psychopathic^ Diseases 

palpitation  of  the  heart,  and  thinks  he  has  some 
trouble  of  a  serious  character.  A  physical  examination 
shows  the  patient  to  be  in  good  condition.  Except  for 
rapidity  and  occasional  irregularity  of  action,  the  heart 
is  quite  normal.  An  examination  discloses  the  fact 
that  the  patient  had  an  early  training  calculated  to 
instil  fears  of  the  supernatural,  fear  of  punishment, 
pain,  sickness,  death.  The  fear  of  committing  a  sin 
was  ingrained  in  the  patient  from  his  very  tender 
childhood.  When  about  the  age  of  nine  he  learned  in 
school  the  habit  of  masturbation  from  his  companions. 
Owing  to  religious  and  moral  scruples,  however,  the 
habit  did  not  get  hold  of  him,  and  he  stopped  for 
several  years  until,  when  about  the  age  of  thirteen,  he 
entered  another  school  and  came  in  contact  with  a  loose 
set  of  boys,  older  than  himself,  who  talked  about 
women  and  thus  excited  his  sexual  passions.  The 
habit  of  self-abuse  continued  with  various  intermissions 
for  two  years,  when  some  quack  literature  fell  into  his 
hands.  He  read  in  quack  pamphlets  about  the  great 
dangers  of  masturbation,  how  it  specially  affected  the 
heart,  giving  rise  to  serious  and  fatal  cardiac  troubles. 
The  boy  became  alarmed;  he  began  to  brood  over  his 
condition,  to  listen  to  his  heart,  and  became  convinced 
that  he  really  suffered  from  a  very  serious  heart  defect 
induced  by  his  habit  of  self-abuse.  After  some  hesita- 
tion he  decided  to  consult  a  heart  specialist,  who  told 
him  that  he  did  have  some  heart  trouble  of  a  nervous 
character.  This  frightened  the  patient,  as  he  thought 
that  the  doctor  did  not  wish  to  inform  him  of  the  gravity 
of  his  disease.  He  next  went  to  another  physician, 
who,  playing  on  his  fear,  told  him  that  his  trouble  was 
really  serious  and  that  he  was  going  to  cure  it.  This 
frightened  the  patient  thoroughly,  and  confirmed  him 
in  his  fears.  The  dread  of  heart  disease  became  fixed. 
For  a  few  years  he  kept  on  suffering  from  heart  trouble 


Clinical  Cases  165 

with  cardiac  pains  and  palpitation, — he  became  a 
typical  psychosomatic  patient.  It  was  the  fear  instinct 
— at  first  aroused  by  religious  and  moral  fears  concern- 
ing the  sexual  function,  and  then  fixed  on  the  heart  in 
an  intensified  way  by  the  reading  of  quack  literature, 
and  heightened  and  cultivated  by  medical  examination 
and  unscrupulous  medical  treatment, — that  figured 
most  prominently  in  this  case. 

C.  L.  Chemist.  American.  Aged  forty-nine.  Fam- 
ily history  good.  Catholic,  very  religious.  Great 
fear  of  sin,  fear  of  punishment,  fear  of  disease,  fear  of 
suffering,  fear  of  death  and  damnation.  About  the 
age  of  nine  the  patient  had  an  attack  of  malaria,  from 
which  he  suffered  for  about  four  years.  This  developed 
a  fear  of  disease  and  death.  When  about  the  age  of 
fifteen  he  learned  from  boys  in  school  about  sexual 
relations,  and  had  many  talks  on  the  subject,  which 
excited  him  so  that  he  began  to  masturbate.  The 
fear  of  the  sin  committed  terrified  him.  The  first 
night  he  masturbated  he  suffered  greatly.  After  the 
act  the  fear  was  so  intense  that  he  prayed  the  whole 
night  through.  A  week  later  he  masturbated  again, 
and  again  passed  the  rest  of  the  night  in  prayer.  He 
then  read  some  quack  pamphlets  and  especially  quack 
advertisements.  He  began  to  fear  the  dangerous 
consequences  of  his  self-abuse.  He  stopped  masturba- 
tion, but  the  fear  of  disease  grew  upon  him.  He  was 
especially  alarmed  on  the  nights  when  he  happened  to 
have  an  involuntary  emission;  he  feared  the  oozing 
away  of  his  vitality, —  a  dangerous  consequence  of 
which  the  quack  advertisements  particularly  warned 
him.  This  fear  lasted  until  the  age  of  twenty-five. 
The  state  of  constant  terror  affected  his  appetite  and 
digestion.  He  went  to  a  physician,  who  told  him, 
after  a  careful  examination,  that  he  was  suffering  from 
gastritis,  and  a  very  dangerous  form  of  it;  that  he  was 


1 66     Causation  and  Treatment,  Psychopathic  Diseases 

going  to  be  sick  in  bed  for  not  less  than  two  years,  and 
that  he  was  going  to  be  an  invaUd  the  rest  of  his  life. 
This  unfavorable  prognosis  was  duly  fulfilled;  the 
patient  went  to  bed,  was  sick  for  a  couple  of  years,  and 
has  become  an  invalid, — a  confirmed  psychosomatic. 
The  fear  instinct  became  cultivated,  fixed  and  centered, 
by  continuous  brooding  over  the  function  of  digestion. 

A  lady  aged  thirty-seven.  From  early  childhood 
fear  of  sickness  and  death.  When  about  fifteen 
she  suffered  from  gastric  and  intestinal  troubles;  had 
severe  attacks  of  dysentery.  About  the  same  time 
she  had  a  shock,  her  little  brother,  age  two,  to 
whom  she  was  much  attached,  died  of  some  intestinal 
affection.  This  aroused  fears  in  regard  to  herself. 
The  patient  was  in  bed  for  two  months.  It  was  then 
discovered  that  she  had  a  slight  lateral  curvature  of  the 
spine.  This  accentuated  the  fear  of  disease  and  death, 
and  increased  the  brooding.  A  few  years  later  the 
patient  suffered  from  a  severe  attack  of  typhoid  fever. 
After  convalescence  she  continued  to  brood,  fearing 
that  she  would  become  an  invalid.  The  fear  of  death 
kept  on  growing  and  finally  gained  mastery  over  her. 
As  the  patient  puts  it:  "I  have  such  an  unmitigated 
horror  of  death.  If  anyone  I  have  ever  seen,  dies,  I  do 
not  sleep  for  weeks.  I  am  afraid,  though  my  reason 
tells  me  how  absurd  it  is." 

Again,  I  have  had  cases  in  which  the  fear  instinct  be- 
came attached  to  the  hair.  Thus,  on  one  young  mar- 
ried lady,  aged  twenty-five,  the  hair  began  to  fall  out. 
She  began  to  worry  over  it  and  to  fear  that  her  beauti- 
ful head  of  hair,  of  which  she  had  been  proud,  would  be 
ruined,  and  that  she  would  become  bald.  She  was  in 
agony  over  the  condition  of  her  hair,  and  finally 
gave  up  all  social  functions,  all  pleasures  and  interests, 
in  life.  Like  Absalom,  she  was  entangled  by  the  fear 
instinct  in  the  tresses  of  her  hair. 


Clinical  Cases  167 

There  are  cases,  too,  somewhat  less  pathetic.  The 
fear  instinct,  like  the  sausage  in  the  nursery  tale,  may 
become  attached  even  to  the  nose.  Thus,  one  of  my 
patients,  a  girl  of  twenty-two,  after  a  series  of  attacks 
of  "la  grippe,"  began  to  worry  and  fear  the  depreda- 
tions of  sickness  on  her  beauty.  Her  attention  finally 
became  centered  on  the  irregularities  of  her  nose,  on 
account  of  coryza.  She  suffered  a  good  deal  in  her 
efforts  to  correct  the  supposed  nasal  defects  and  then 
decided  to  go  to  a  specialist,  who  took  advantage  of 
her  ignorance  and  fear,  and  performed  a  slight  opera- 
tion to  improve  the  beauty  of  the  nose.  As  fate  would 
have  it,  he  apparently  infected  her  during  the  opera- 
tion, pimples  breaking  out  all  over  her  face.  The  fear 
became  a  terror,  a  panic.  The  fear  instinct  obsessed 
her  through  the  intermediation  of  her  nose. 

Mrs.  J.  A.,  fifty-eight.  Loss  of  strength  in  left  arm 
and  leg,  set  in  three  years  ago.  Fears  great  exhaustion, 
faints.  Was  not  a  strong  child.  Had  pneumonia. 
Married  at  twenty-four;  had  one  boy;  had  fear  of 
hemorrhage.  Had  fear  her  boy  was  dying  from 
fractured  skull, — beam  fell  on  his  head  at  the  age  of 
seven.  Patient  was  in  an  accident  with  runaway 
horse.  Patient  took  care  of  husband  when  he  suffered 
from  typhoid  fever. 

M.  C.  G.,  thirty-eight.  Liquor  dealer.  Brother 
died  of  heart  trouble.  Sister  has  heart  trouble. 
Mother  died  of  pneumonia,  when  age  forty.  Nervous 
temperament  since  childhood.  Spelling  troubled  him; 
had  difficulty  of  going  into  business  on  account  of  spel- 
ling; too  sensitive  about  It;  wants  everything  in  good 
order,  "apple-pie  order."  Rarely  suffers  from  head- 
ache. Suffers  from  sleeplessness  at  present.  Has  been 
brooding  over  fear  of  poor  spelling,  which  has  made 
him  lose  confidence  in  himself.  Excessive  smoking; 
after   his   wife's    death   he    had    accident,    fell    down 


1 68     Causation  and  Treatment,  Psychopathic  Diseases 

unconscious,  and  fancied  knee  broken.  He  has  fears 
that  business  is  going  to  the  dogs;  that  he  is  un- 
able to  pay  his  bills;  that  his  second  wife  may  marry 
after  he  dies;  that  people  criticise  him  too  much.  He 
has  intense  fear  that  some  terrible  misfortune  may  happen 
to  him  or  to  his  children,  or  to  any  of  his  family.  He 
suffers  from  fear  of  incapacity;  from  fear  of  fear;  con- 
stantly   asks    for    "confidence,    confidence." 

Mr.  R.  Age  thirty-six.  Married.  Professor  of 
mechanical  engineering.  As  a  child  was  timid,  full  of 
fears  of  dark,  of  sickness,  of  being  dead,  of  being  pun- 
ished and  ill  treated.  In  1904  stayed  in  a  hotel  with 
tubercular  patients.  For  some  time  has  been  worrying 
over  his  poor  health  and  worn  down  condition.  That 
night  he  became  afraid  of  the  seriousness  of  his  present 
state,  and  possibly  of  his  having  tubercular  trouble. 
He  became  afraid  that  his  wife  might  have  also  suffered 
from  tuberculosis,  and  may  possibly  have  a  serious 
attack  of  it.  His  wife  has  been  in  rather  precarious 
health  for  some  time.  As  a  student  he  attended  to  a 
friend  of  his  who  suffered  from  tuberculosis.  Recently 
a  friend  discussed  with  him  about  contagion.  The 
friend  was  apparently  affected  with  the  phobia  of 
contagion, — at  the  least  occasion  or  suspicion  the  latter 
used  antiseptics.  This  fear  of  tuberculosis  has  taken 
possession  of  the  patient,  and  makes  it  difficult  for  him 
to  carry  on  his  teaching, — his  mind  is  full  of  fear  of 
disease  and  possible  contagion. 

P.  G.  B.  Age  seventeen.  Had  appendicitis  about 
age  fourteen.  Suffers  colds,  and  coughs  occasionally. 
Dreams  little.  Heart  irregular;  lungs  good.  Patellar 
reflex  lively. 

Patient  feels  odd,  automatic,  things  look  far,  feels 
faint.  He  has  fear  of  remaining  alone.  Heart  troubles 
him  a  little;  has  fear  of  going  in  car.  He  is  afraid 
something  will  happen  to  him.     Thinks  he  has  lost 


Clinical  Cases  169 

self-control.  He  is  afraid  of  himself,  and  afraid  of 
seeing  people.  Thinks  something  terrible  may  hap>- 
pen  to  him.  Patient  has  few  dreams;  becomes  ex- 
hausted in  sleep.  Everything  looks  like  nonsense, 
not  on  the  earth;  has  attacks  of  fainting  and  fear  after 
which  he  feels  somewhat  better;  is  afraid  of  everything. 
Patient  has  attacks  of  dizziness  with  agoraphobia. 
He  has  a  fear  of  doing  things,  the  mere  necessity  of 
doing  causes  fear.  Patient  was  timid,  full  of  fears  from 
his  very  childhood. 

S.  S.,  thirty-six.  Became  frightened  because  he 
saw  a  man  who  had  committed  suicide.  Patient  of 
timid  nature,  nervous.  The  same  day  when  he  saw 
the  man  he  heard  a  voice  telling  him  to  commit  suicide. 
Mother  had  twice  an  attack  of  what  he  called  "crazi- 
ness."  She  received  a  letter  that  her  brother  died,  the 
fright  brought  about  an  attack.  His  sister  had  attack 
of  melancholia. 

Patient  kept  on  thinking  about  the  man  who  com- 
mitted suicide.  The  same  night  he  had  the  dream 
that  someone  told  him  to  commit  suicide.  He  is  afraid 
to  go  into  a  barber-shop. 

E.  A.,  twenty-eight,  not  married,  silk  worker.  Ner- 
vous; father  and  mother  well. 

As  a  child  was  sensitive,  timid;  headaches  ten  years 
old,  eyes  then  corrected  by  glasses;  not  much  better; 
began  to  work  when  about  seventeen;  worries  about 
his  fortune;  did  not  sleep;  feels  restless;  face  drawn; 
has  taken  all  kinds  of  medicines;  never  satisfied  with 
anything;  sleeps  well;  appetite  good;  mentally  he 
claims  he  is  in  hell,  feels  as  if  he  were  dead.  Mastur- 
bated little;  lived  a  pure  life. 

Thinks  too  much  about  himself;  wanted  to  be  a 
singer;  lost  his  voice  by  thinking  of  himself.  "I  could 
begin  to  cry  and  weep  about  myself." 

Mr.    H.    W.     Married.     Age    twenty-six.     Patient 


lyo     Causation   and   Treatment,  Psychopathic  Diseases 

thinks  he  has  consumption.  When  walking  down 
street,  trembles  and  shakes,  feels  like  fainting  away. 
Cannot  go  alone,  must  go  with  some  one.  Afraid  to 
go  insane  or  drop  dead.  The  first  attack  five  years  ago 
lasted  about  seven  months.  Thought  he  had  con- 
sumption before  the  attack,  because  of  profuse  sweat, 
he  was  feverish.  He  used  to  watch  over  his  con- 
sumptive brother,  thinks  about  his  health,  sleeps 
restlessly.  This  worry  about  consumption  began  when 
he  was  about  sixteen  or  seventeen  years  old;  used  to 
suffer  from  shaking  spells  of  fear.  Things  appear  to 
him  unreal.  Patient  reads  about  people  committing 
suicide,  he  is  afraid  of  losing  his  mind.  Dreams  about 
sickness  and  death,  had  bad  nightmares.  Attention 
is  poor. 

He  told  me  that  he  began  to  masturbate  when  about 
eleven  and  that  it  continued  for  four  years.  He  was 
afraid  that  it  would  undermine  his  powers,  energies. 
Fear  instinct  associated  with  sex. 

Mrs.  M.  F.,  age  thirty-eight.  Patient  suffers  from 
digestive  disturbances.  "Never  had  any  luck";  patient 
complains  of  "liver  disorder";  headaches  and  pain  dur- 
ing menstruation;  the  feeling  of  unreality  becomes 
more  intense  during  menstruation;  does  not  suffer  from 
bad  dreams.  Suffers  from  severe  headaches,  from  feel- 
ing of  unreality.  Patient  has  fear  of  unreality,  afraid 
of  it.  She  is  afraid  of  losing  her  mind;  has  a  kind  of 
dizzy  sensation  in  head;  she  is  afraid  of  going  on  the 
street,  because  she  is  afraid  of  an  attack  of  "epilepsy 
or  apoplexy."  Father  had  a  stroke  of  paralysis,  and 
mother  had  a  stroke  of  apoplexy.  Both  parents  were 
paralyzed,  and  patient  attended  on  them.  Patient 
suffers  from  fear  fatigue.  The  whole  state  is  one  of 
intense  worry  about  herself,  and  about  her  health.  In- 
tense pathophobia. 

M.  Jeff.,   twenty-five,     Russian   Jew.    Florist.     He 


Clinical  Cases  I71 

always  was  very  nervous,  timid.  A  year  ago  contracted 
gonorrhoea.  Got  greatly  frightened.  Then  he  had 
nose-bleed.  He  bought  books,  read  on  the  subject, 
became  terrorized.  He  was  afraid  of  falling  to  pieces. 
He  went  to  a  physician,  who  gave  some  medicine; 
he  inhaled  the  medicine  which  hurt  him.  Began  to 
cry,  he  was  falling  to  pieces.  He  thought  he  was 
burning,  his  brain  was  on  fire.  He  is  now  in  constant 
terror  of  ruin.  Fears  that  his  body  will  rot  away. 
This  fear  he  contracted  from  hearsay  about  people 
infected  with  venereal  diseases.  The  fear  was  strongly 
impressed  on  the  patient  in  his  early  youth. 

Mr.  H.  L.,  twenty-eight.  Three  years  ago  began 
to  complain  of  heart  trouble,  body  trouble;  suffers 
from  agoraphobia;  impulsive  ideas  to  do  things.  In- 
sistent ideas:  What  is  mind.''  What  is  body?  Why 
did  I  say  this?  Questions  himself  constantly.  Tries 
to  remember  things;  he  cannot  remember.  Suffers 
from  anxiety  and  fear.  Complains  of  visual  troubles. 
Suffers  from  moral  and  religious  fears;  full  of  fear  of 
everything.  Thinks  of  eyes,  mouth,  tongue;  wants  to 
know  cause  of  every  movement  of  the  body.  Listen- 
ing to  breathing.  Everything  gives  rise  to  thoughts 
full  of  fear  and  anxiety.  Picks  up  things,  forms  new 
fears;  has  an  overwhelming  fear  of  death.  Drank 
whiskey  for  stimulation;  fear  tortures  him. 

When  he  spits  he  wants  to  know  why;  when  he  walks 
he  wants  to  step  over  pieces  of  paper;  picks  up  papers. 
When  habit  is  broken  he  gets  scared.  He  is  scared  all 
the  time.  Keeps  on  counting.  Whatever  he  sees  he 
wants  to  touch.  Everything  a  person  talks  about 
enters  into  his  mind  and  excites  fear.  The  fear  instinct 
and  the  impulse  of  self-preservation  have  obtained  an 
overwhelming  control  over  the  patient's  mind. 

Mr.  M.  F.,  twenty-four.  (Spanish,  Porto  Rico.) 
When  fourteen  had  attack  of  fear,  sudden  fright  of 


172     Causation  and  Treatment,  Psychopathic  Diseases 

devil.  The  fear  lasted  a  few  minutes.  Three  years 
ago  had  a  similar  attack,  fear  of  devil  with  fright  of 
insanity.  Has  attack  and  then  has  a  fear  of  committing 
suicide.  The  actual  attack  lasts  a  few  minutes,  but 
patient  keeps  on  worrying  a  long  time  afterwards. 
Has  fear  of  eternal  damnation.  The  attack  comes  first, 
and  then  fear  of  committing  suicide  and  being  damned 
forever.  Dreams,  nightmares,  leave  emotional  after- 
effects during  the  day  and  waking  life.  Education  re- 
ligious. Patient  lived  in  insane  asylum  since  early 
childhood. 

Mrs.  A.  F.,  age  forty-three.  Husband  has  been 
drinking  more  than  usual,  has  been  very  unpleasant; 
she  became  nervous  and  began  to  worry  about  it. 
Worries  about  herself;  is  afraid  of  going  insane,  is 
afraid  will  never  get  out  of  it.  She  was  kept  in  bed  for 
two  or  three  months.  Got  some  drugs.  She  feels 
that  a  stream  is  going  down  her  back.  Heart  in  good 
condition.  Has  an  idea  that  her  brain  had  given  away. 
Complains  of  intense  fear.  When  put  into  hypnoidal 
state  she  became  very  much  frightened;  intense  fear 
since  childhood.  Patient  is  afraid,  does  not  know  of 
what. 

Mr.  W.,  age  sixty-one.  Neurasthenia,  internal 
troubles,  his  own  diagnosis — catarrh  of  the  stom.ach, 
lost  forty  pounds.  Suffers  from  hyperaesthesia  of  the 
intestinal  tract;  feels  depression;  worries  about  every 
thing.  Fears  he  is  going  to  be  ruined,  afraid  to  go  out, 
he  might  die.  Has  fear  dreams,  reproduction  of 
waking  fears;  cannot  concentrate  his  attention.  At 
daytime  obsessed  with  fear  of  death.  When  young 
was  very  nervous,  he  had  his  mind  upon  sickness 
and  death.  Has  also  fears  about  various  bodily  organs, 
and  about  his  children.  Afraid  he  may  take  the  wrong 
train  or  the  wrong  trolley. 

Mr.  D.  S.    When  a  child  of  five  had  scarlet  fever; 


Clinical  Cases  173 

no  other  diseases.  Began  to  have  headaches  some  two 
years  ago;  troubles  of  Indigestion  began  about  ten 
years  ago;  bad  feelings  in  the  throat  and  heart. 
Troubles  began  after  father's  death  which  preyed  on 
his  mind  for  years.  Began  to  feel  the  present  symp- 
toms about  ^J.4  years  ago,  in  New  York,  when  he  faint- 
ed and  was  afraid  of  dying.  Since  that  time  he  has 
attacks  of  fear,  has  feeling  of  anxiety.  When  he  gets 
up  he  feels  as  if  sleep  did  not  refresh  him.  Has 
dreams  about  his  father.     His  sleep  is  disturbed. 

In  hypnotic  state  cried  out:  *'I  am  afraid  I  am  getting 
crazy."  Gradually  got  him  out  of  this  condition  and 
he  began  to  feel  well,  though  he  complained  of  sensation 
of  lightness  in  the  head. 

Ed.  H.  Age  43,  lawyer.  Was  irritable  in  childhood, 
used  to  kick  and  scream;  as  a  child  had  to  have  his 
own  way.  Had  idea  that  he  was  left-handed  (though 
he  was  not);  had  "stubborn"  ideas.  Has  fears  about 
drugs.  When  riding  bicycle  was  afraid  about  falling; 
the  same  about  horses  when  he  fell  down.  Fears 
are  formed  whenever  accident  occurs.  When  older, 
formed  apprehension  about  many  matters.  Worried 
over  his  business.  Patient  began  to  speculate  on  the 
exchange  and  lost,  became  nervous,  and  did  not  im- 
prove since. 

Mrs.  L.  A.,  age  forty-two,  married.  Two  children. 
Had  fears  of  paralysis.  Was  very  suggestible  in  regard 
to  fear.  Sleep  was  good,  menstruated  about  age  of 
fourteen. 

Was  afraid  to  remain  alone.  Became  interested  in 
Christian  Science.  Felt  revulsion  at  A's  proposal; 
cannot  account  for  it.  Patient  thinks  husband  is  con- 
cealing something  from  her.  Suffered  agony  every  day 
during  first  pregnancy;  imagined  husband  behind  pris- 
on bars.  "This  frightful  barrier  has  always  been  be- 
tween them."     Patient  suffered   from  insomnia   and 


174     Causation  and    Treatment,  Psychopathic  Diseases 

from  extreme  nervousness.  There  was  a  woman  who 
influenced  her  in  regard  to  marriage.  Husband  drinks 
and  to  excess.  Read  about  a  young  woman  who  com- 
mitted suicide.     Intense  fear  state. 

Miss  A.  A.  Age  thirty-seven.  At  sixteen  fell  down 
from  horse,  has  been  ailing  since;  then  had  an  opera- 
tion for  internal  tumor.  In  a  sanitarium  for  four  years; 
sunstroke,  dizziness,  fear  (agoraphobia),  and  claustero- 
phobia.  Heart  good,  normal;  reflexes  normal;  anemia 
and  insomnia. 

Indigestion,  constipation.  Has  been  taking  bro- 
mides; dizziness.  Pathophobia;  fears  from  early  child- 
hood. 

Mrs.  M.  C,  aged  thirty-two  years,  American. 
Family  history  good;  well  developed  physically  and 
mentally.  A  year  before  the  present  trouble  set  in, 
patient  sufl"ered  from  a  severe  attack  of  the  grippe. 
Menstruation,  which  was  before  painless  and  normal 
in  amount,  became  painful  and  scanty,  accompanied  by 
headaches,  indisposition,  irritability,  crying  spells,  and 
backache  which  lasted  long  after  the  menstrual  period 
was  over.  There  was  a  slight,  somewhat  thick, 
leucorrheal  discharge.  The  family  physician  ascribed 
the  symptoms  to  endometritis,  mainly  cervical,  and 
treated  her  with  absolute  rest,  fomentations,  injections, 
scarification  and  dilatation  of  the  cervix,  and  finally 
curetted  the  uterus.  As  the  patient  grew  worse  under 
the  treatment,  she  was  taken  to  a  gynecologist,  who, 
after  an  examination,  declared  the  whole  trouble  to  be 
due  to  retroflexion  of  the  uterus,  and  suggested  an 
operation  for  reduction.  The  operation  was  duly 
performed,  with  the  result  that  the  nerv^^ous  symptoms 
became  intensified  and  the  attacks  increased  in  violence 
and  duration.  The  turn  of  the  nerve  specialist  came 
next.  Hysteria,  neurasthenia,  and  the  more  fashion- 
able "psychasthenia"  have  been  diagnosed  by  various 


Clmical  Cases  175 

neurologists,  A  year  of  psychoanalysis  made  of  the 
patient  a  complete  wreck,  with  depression,  introspec- 
tion, and  morbid  self-analysis.  Patient  was  put  by 
neurologist  under  Weir  Mitchell's  treatment. 

When  the  patient  came  under  my  care,  she  was  in 
mental  agonies,  a  complete  wreck.  A  study  of  the 
case  traced  the  fear  instinct  to  experiences  of  early 
childhood,  fears  accentuated  and  developed  into  morbid 
states  by  the  deleterious  tendencies  of  the  treatment, 
giving  rise  to  a  somatopsychosis. 

A  lady,  age  fifty-nine,  suffered  from  kyno- 
phobia.  When  about  the  age  of  twenty-nine 
she  was  bitten  by  a  dog;  since  then  she  was  afraid 
of  hydrophobia.  She  kept  on  reading  in  the  papers 
about  cases  of  hydrophobia  until  the  fear  became 
developed  to  an  extraordinary  degree  and  became  fixed 
and  uncontrollable.  According  to  the  principles  of 
evolution  of  psychopathic  states,  the  fear  kept  on 
extending.  The  fear  psychosis  included  all  objects 
that  might  possibly  carry  the  germ  of  hydrophobia. 
The  neurosis  became  a  mysophobia. 

As  in  all  other  cases  of  psychopathic  states  the 
psychosis  was  traced  to  the  fear  instinct  the  germ  of 
which  was  laid  in  the  patient's  early  history.  The 
patient  was  a  very  timid  child  and  was  afraid  of  strange 
animals.  In  the  village  where  she  lived  there  were  a 
few  cases  of  hydrophobia  which  impressed  her  when  a 
child.  This  germ  was  in  later  life  developed  by  thirty 
years'  cultivation. 

A  well-known  physiologist  reports  to  me  that  his 
little  child  up  to  three  and  a  half  was  not  afraid  of 
anything,  not  even  of  the  dark.  At  that  age  she 
was  taken  to  the  country  and  there  associated  with 
servant  girls  who  were  afraid  of  the  dark  and  especially 
of  storms  and  thunders.  One  of  the  girls  who  was 
Nova  Scotian  and  extremely  superstitious,  was  in  terror 


176     Causation  and   Treatment,  Psychopathic  Disease-^ 

of  thunder.  Since  that  time  the  fear  of  darkness  and 
especially  the  fear  of  thunder  took  possession  of  the 
little  child  by  imitation  and  suggestion.  In  fact,  the 
girl  who  takes  care  of  the  child  is  also  afraid  of  the 
thunder,  and  this  is  comimunicated  to  the  child.  There 
is  absolutely  no  other  cause  to  the  fear  as  the  parents 
had  the  child  under  their  direct  and  strict  observation 
and  care. 

Similarly  I  have  known  a  number  of  cases  where 
people  had  accidents,  thunderstorms,  the  lightning  strik- 
ing close  to  them,  and  who  have  become  afraid  of  thun- 
derstorms the  rest  of  their  life.  The  interesting  point 
about  it  is  the  fact  that  the  people  who  happened  to 
live  with  them  in  the  same  house,  and  who  before  have 
not  been  afraid  of  lightning  and  thunder,  have  ac- 
quired the  fear  and  were  in  terror  of  storms,  lightning, 
and  thunder. 

Psychopathic  symptom  complexes  I  observed  in 
children  whose  early  training  was  favorable  to  the 
awakening  and  development  of  the  fear  instinct.  In 
children  affected  with  fear  of  animals  I  traced  the  fear 
psychosis  to  the  parents  who  were  afraid  of  animals, 
on  account  of  actual  traumas  in  their  life  history,  the 
child  being  influenced  by  imitation,  by  suggestion, 
often  subconscious,  by  the  behavior  of  the  parents  in 
the  presence  of  animals.  Such  children  are  predisposed 
to  recurrent  psychopathic  states. 

In  all  such  cases  the  etiology  is  easy  to  find,  if  the 
patient  is  carefully  examined.  In  many  cases  the 
fear  instinct  with  its  symptom  complex  is  associated 
with  external  objects,  giving  rise  to  the  so-called 
phobias.  Instead,  however,  of  being  associated  with 
external  objects,  the  fear  instinct  is  frequently  associ- 
ated with  somatic  functions  (pathophobia)  or  with 
mental  activities  (phrenophobia). 

Man,    age     forty-seven;     actor;    family     neurotic. 


Clinical  Cases  I77 

Patient  suffered  from  anorexia,  indigestion,  choking, 
vomiting,  gagging,  eructation,  gastralgia,  and  oc- 
casional pains  in  the  limbs.  He  led  a  rather  gay  and 
irregular  life  up  to  the  age  of  thirty-two,  when  he 
had  syphilis,  for  which  he  was  under  treatment  for  two 
years.  This  scared  him,  because  he  had  the  opportunity 
to  see  the  consequences  of  syphilis  in  many  of  his  friends. 
He  had  been  under  continual  fear  of  the  possibility  of 
development  of  parasyphilitic  diseases.  Seven  years 
ago,  at  the  age  of  forty,  he  had  to  watch  at  the 
bedside  of  an  intimate  friend,  who  had  been  suffering 
from  severe  gastric  crises  of  tabes  dorsalis.  After  one 
specially  exhausting  night  of  vigil,  worry,  and  fear,  he 
went  to  bed  for  a  short  nap  and  woke  up  with  the  idea 
of  general  paresis  and  intense  fear.  Since  that  time 
he  began  to  suffer  from  symptoms  of  tabes  with  fear 
of  general  paresis. 

Patient  had  been  a  very  imaginative  child;  had  his 
fear  instinct  cultivated  from  early  childhood  by  stories 
of  frights,  scares,  and  horrible  accidents.  When  ten 
years  old,  grandfather  gave  him  Faust  to  read.  Since 
then  patient  was  troubled  with  the  fear  of  selling  his 
soul  to  Satan.  Was  very  religious  in  his  childhood, 
prayed  much,  was  possessed  by  the  fear  of  committing 
sins.  "It  has  now  all  come  back,"  he  complained. 
A  great  number  of  fears  could  be  traced  to  his  early 
childhood.  The  somatic  symptoms  were  the  manifesta- 
tions of  association  of  experiences  of  parasyphilitic 
diseases,  based  on  the  pathological  state  of  the  fear 
instinct,   a   case   of  pathophobia,   a   somatopsychosis. 

H.  M.,  age  twenty-seven,  male,  Canadian.  Fam- 
ily history  good;  looked  pale,  anemic,  and  frail;  very 
intelligent,  sensitive,  restless,  and  had  a  tendency 
to  worry.  About  a  year  ago,  he  began  to  feel  depressed, 
to  worry  about  his  health;  thought  he  suffered  from 
tuberculosis.     His  physician  assured  him  that  nothing 


178     Causation  and  Treatment,  Psychopathic  Diseases 

was  the  matter,  but  he  had  uncontrollable  fear  of 
consumption,  and  the  fear  kept  on  recurring.  Up  to 
the  age  of  nineteen  he  was  perfectly  well.  He 
was  then  laid  up  with  a  sore  knee  for  a  few  weeks. 
He  had  time  enough  to  brood  over  the  knee  and  read 
some  literature  on  the  subject.  He  thought  it  was 
tuberculosis  and  worried  very  much.  The  knee, 
however,  got  well,  and  gradually  he  forgot  all  about  It, 
although  the  fear  of  tuberculosis  often  made  him  feel 
uncomfortable,  and  the  fear  of  "water  in  the  knee" 
used  to  flash  through  his  mind,  to  pass  away  the  next 
moment.  A  year  ago,  however,  he  happened  to  lose 
his  work,  became  despondent,  began  to  worry  and  to 
brood  over  his  financial  troubles,  slept  restlessly, 
suffered  from  anorexia,  and  began  to  lose  flesh.  The 
fear  of  the  knee  and  the  fear  of  tuberculosis  got 
possession  of  him.  He  could  not  rid  himself  of  the  fear 
of  tuberculosis.  If  In  the  clinic,  the  physician  assured 
him  that  he  was  all  right,  he  felt  better  for  a  couple  of 
hours;  but  often  It  did  not  last  even  as  long  as  that. 
The  least  pain,  cough,  heart  beat,  a  feeling  of  chill  or 
heat,  and  the  like,  brought  the  fear  of  tuberculosis  back 
to  his  mind  with  renewed  energy.  He  was  obsessed  by 
the  fear  of  tuberculosis  and  felt  he  was  doomed  to  cer- 
tain death,  a  psychosomatic  pathophobia. 

Man,  age  forty-three,  suffered  from  palpitation 
of  the  heart,  fainted  easily,  especially  on  physical 
examination  by  physician,  or  at  the  beginning  of 
medical  treatment.  He  suffered  from  indigestion  for 
which  he  had  been  under  treatment  for  a  number  of 
years  by  physicians  who  gave  him  medicine  for  his 
bowels,  and  also  from  time  to  time  kept  on  washing  his 
stomach.  He  had  a  great  fear  of  becoming  a  victim 
of  cardiac  troubles,  especially  of  some  unknown, 
terrible,  valvular  affection.  When  under  my  care  he 
kept  on   asking  to  be  taken   to  heart  and   stomach 


Clinical  Cases  179 

specialists  to  be  examined,  and  have  some  radical 
operation  performed.  Frequently  under  the  influence 
of  the  fear  states  and  obsession  of  heart  and  stomach 
trouble,  especially  the  heart,  he  would  collapse  suddenly, 
be  unable  to  walk,  and  be  afraid  that  he  suffered  from 
some  paralysis. 

On  examination,  the  patient  revealed  a  history  full  of 
various  traumas  which,  from  his  very  childhood  until 
he  came  under  my  care,  helped  to  bring  about  his 
psychopathic  condition,  and  developed  the  fear  instinct 
to  an  extraordinary  degree. 

Physicians  had  the  lion's  share  in  this  special  case 
by  their  rearing  of  the  fear  instinct,  and  by  their 
favoring  the  patient's  phobias  by  their  examinations, 
by  their  prescriptions,  and  by  the  diet  and  treatment. 
The  patient  was  in  such  a  panic  that  he  kept  on  taking 
his  pulse  at  the  least  occasion,  was  feeling  his  heart, 
stomach,  and  intestines  at  every  opportunity.  The 
hypertrophied  growth  of  the  fear  instinct  had  invaded 
and  dominated  the  patient's  whole  personality, 
developed  a  typical  psychosomatic  pathophobia  with 
its  recurrent  states. 

In  the  Trudi  for  191 3  of  the  Imperial  University 
of  Moscow,  Russia,  Doctor  Ribakov  makes  an  extensive 
study  of  a  series  of  cases  of  psychopathic  asthma  and 
arrives  at  a  conclusion  similar  to  my  own,  although  he 
is,  no  doubt,  unaware  of  my  work  and  publications  on 
the  same  subject.  He  comes  to  the  same  conclusion 
with  me  that  the  etiology  of  neurosis  is  to  be  found  in 
fear  which  alone  forms  the  basis  of  psychopathic 
neurosis.  All  other  factors,  social,  professional,  sexual, 
religious,  are  only  occasions  of  the  disease.  It  is  fear 
and  the  morbid  impulse  of  self-preservation  that  form 
the  pathology  of  the  psychopathic  symptom  complex. 

A  young  lady  was  afflicted  with  ornithophobia, 
fear  of  birds,  fear  of  chickens.    The  sight  of  a  chicken 


l8o     Causation  and  Treatment^  Psychopathic  Diseases 

set  her  into|a  panic.  The  patient  is  very  timid,  and 
this  timidity  can  be  traced  to  her  early  childhood. 
When  at  the  age  of  six  years,  a  playmate  threw  at  her 
in  the  dark  a  live  chicken.  The  child  was  terribly 
frightened,  screamed,  and  fainted.  The  mother  used 
to  tell  her  fairy  stories  full  of  adventures,  of  ghosts, 
of  dragons,  and  of  monsters.  This  prepared  the  patient 
to  react  violently  to  the  sudden  attack  made  by  the 
flight,  struggling,  and  feel  of  the  chicken  in  the  dark. 
Since  that  time  patient  has  formed  an  uncontrollable 
fear  of  live  birds. 

Another  patient  of  mine,  a  lady  of  forty-nine  years, 
single,  suffered  from  potamophobia,  a  fear  of  going 
into  rivers,  or  into  the  ocean.  When  about  seven  years 
old  she  was  thrown  into  water  by  one  of  her  elder 
sisters.  She  was  nearly  drowned,  and  was  half  dead 
with  fear  when  rescued.  Since  then  she  has  been  in 
terror  of  water,  or  rather  of  rivers  and  oceans.  Several 
times  she  made  conscious  efforts  to  get  rid  of  the  fear, 
but  the  attempts  were  unsuccessful.  In  fact,  the  more 
she  was  forced  or  forced  herself  consciously  to  get  into 
water,  the  greater  was  the  fear.  This  fear  became  all 
the  more  intensified,  when  some  of  her  intimate  friends 
were  drowned  in  a  boat.  This  fixed  the  fear  which 
became  uncontrollable. 

A  man  of  thirty-five  years  was  afraid  of  going  out 
in  the  dark.  This  was  traced  by  me  to  early  associ- 
ations of  fears  of  the  dark,  to  superstitious  beliefs 
in  ghosts  and  spirits,  cultivated  in  the  patient's 
early  childhood.  He  was  afraid  to  remain  alone  in 
the  dark  or  to  go  down  at  night  into  cellars  or  other 
secluded  places.  This  fear  was  unfortunately  still  more 
intensified  by  an  accident.  At  the  age  of  twenty-seven, 
one  night  when  returning  late  from  a  visit,  he  was 
assaulted  from  behind  by  foot-pads.  This  accident 
fixed  the  fear  of  darkness. 


Clinical  Cases  i8i 

A  lady  of  sixty-seven  years,  with  pronounced  ar- 
teriosclerosis, had  an  a  ttack  of  hemiplegia  of  the  left 
side.  She  suffered  from  motor  aphasia,  but  did  not 
lose  consciousness.  The  paralysis  cleared  up  in  a  few 
days,  but  the  sudden  attack  demoralized  her.  Since 
that  time  she  is  in  teiror  of  another  attack.  She 
watches  for  symptoms,  and  the  least  sensation  of 
faintness  throws  her  into  a  panic.  The  patient  is  the 
wife  of  a  general  and  was  in  China  during  the  Boxer 
riots,  in  the  Spanish  American  war,  in  the  Philippines 
and  other  military  engagements.  The  fear  instinct 
was  cultivated  in  her  by  all  such  conditions.  In  her 
early  childhood  there  were  fears  and  frights  of  child 
character,  enough  to  arouse  the  fear  instinct  which  was 
gradually  developed  and  cultivated  by  the  circum- 
stances of  life  and  by  worries  in  the  course  of  the 
various  wars  in  which  she  participated  or  of  which  she 
was  a  witness.  Finally  the  fear  culminated  by  the 
stroke  of  paralysis. 

Similarly,  I  had  other  patients  who  suffered  from 
tuberculosis,  from  asthma,  from  heart  trouble,  and  from 
all  kinds  of  intestinal  affections  which  specially  abound 
in  psychopathic  cases.  All  such  cases  can  be  clearly 
traced  to  various  somatic  symptoms,  based  on  the 
fear  instinct.  The  etiology  is  fear,  the  arousal  and 
development  of  the  fear  instinct  in  respect  to  the 
special   symptom   complex. 

A  patient,  age  twenty-five,  suffered  from  agora- 
phobia at  various  intervals.  As  a  child  of  nine 
years,  he  was  attacked  by  rough  boys.  He  freed 
himself  and  ran  in  great  terror.  The  boys  threatened 
him  with  another  "licking"  when  he  appeared  again 
on  the  street.  He  was  afraid  to  go  out  for  several  weeks. 
The  parents  forced  him  to  go  and  buy  some  things. 
Living  in  a  rough  neighborhood,  on  account  of  his 
father's   reduced  circumstances,   he    has    been   many 


1 82     Causation  and  Treatment,  Psychopathic  Diseases 

times  subjected  to  knocks,  blows,  and  assaults  by  rough 
boys,  until  the  fear  of  the  open  street  became  fixed 
into  the  well-known  form  of  agoraphobia. 

Another  case,  that  of  a  lady  of  thirty-eight  years, 
married,  suffers  from  ailurophobia,  or  fear  of  cats. 
This  can  be  traced  to  the  patient's  early  childhood. 
When  she  was  a  child,  her  brothers  and  sisters  went 
through  attacks  of  diphtheria,  which  were  ascribed  to 
infection,  caused  or  transmitted  by  cats.  The  patient 
was  specially  impressed  with  the  danger  from  cats. 
Under  such  training  and  suggestion  given  in  early 
childhood,  the  patient  gradually  formed  a  fear  of  cats. 
This  fear  was  still  more  intensified  and  became  a  panic 
when  she  was  put  into  a  dark  room  and  a  cat  was  let 
loose  on  the  poor  victim  by  her  mischievous  companions 
who  knew  of  the  patient's  fear.  When  the  patient  had 
children  of  her  own,  she  was  still  m.ore  affected  by  the 
fear  of  cats,  on  account  of  the  subconscious  and  con- 
scious fear  of  infection  that  may  have  been  transmitted 
by  cats  to  her  children. 

P.  J.  Male.  Age  thirty-five.  Patient  is  run  down, 
much  under  weight;  digestion  poor;  suffers  from 
nausea  and  vomiting.  Occasionally  suffers  from  head- 
aches. He  is  suspicious;  afraid  he  may  become  insane. 
Anything  in  the  remotest  way  associated  with  insanity 
is  apt  to  excite  and  depress  him.  He  is  successful  in 
his  profession  as  lawyer;  has  been  elected  to  responsible 
offices.  He  is  well  connected  socially  and  politically. 
The  present  malady  he  keeps  well  under  control  so 
that  only  his  wife  has  any  inkling  of  his  illness. 

The  central  fear  is  hematophobia,  a  fear  of  blood. 
This  hematophobia  kept  on  growing  and  spreading  until 
it  now  occupies  his  whole  field  of  mental  vision.  The 
hematophobia  kept  on  extending,  involving  more  and 
more  remote  associations.  Anything  that  may  possibly 
remind  the  patient  of  blood  is  an  object  of  intense  fear 


Clinical  Cases  183 

and  anxiety,  accompanied  with  intense  suffering,  nausea, 
vomiting,  paleness,  fainting,  and  extreme  weakness  of 
the  whole  body.  An  attack  or  a  paroxysm  of  fear  is 
often  followed  by  a  couple  of  hours  of  deep  sleep. 
After  such  a  sleep  the  patient  usually  feels  well.  The 
attack  simulates  larval  or  psychic  epilepsy. 

Patient's  parents  suffered  from  some  form  of  hemato- 
phobia  which  seemed  to  have  strongly  impressed  the 
children.  Patient's  brother  was  affected  with  similar 
phobia  though  not  so  intense  in  character. 

When  about  the  age  of  six,  patient  remembers  that 
his  brother  cut  his  finger.  The  bleeding  greatly  fright- 
ened the  parents  and  the  two  boys.  The  bleeding 
finger  was  put  in  something  that  smelt  like  iodoform. 
Since  then  that  smell  is  hateful  to  the  patient.  Patient 
cannot  trace  his  fear  to  anything  before  the  age  of  six, 
but  he  thinks  that  the  attacks  may  date  to  still  earlier 
experiences.  Since  that  time  of  the  bleeding  finger 
patient  can  trace  clearly  his  attacks  which  became 
more  frequent,  more  persistent,  and  more  uncontrol- 
lable. Anything  reminding  of  blood  in  the  remotest 
way  sets  the  patient  in  a  paroxysm  of  fear  which  he  has 
great  difficulty  to  conceal.  When  he  takes  a  shave  he 
must  be  extremely  careful  not  to  cut  himself.  The 
sight  of  a  drop  of  blood  causes  him  to  faint.  He  can- 
not read  physiology,  anatomy,  or  any  description  of 
blood  or  circulation  of  blood.  The  patient  is  in  terror 
of  some  vague  evil.  The  fear  spreads  and  grows  to  an 
extraordinary  degree.  He  is  afraid  to  address  a  jury, — 
something  awful,  some  evil  may  happen. 

When  I  wanted  to  put  my  stethoscope  on  his  chest, 
he  became  scared.  When  I  tried  to  take  his  blood 
pressure,  he  became  frightened,  objected  strongly,  then 
agreed.  The  examination  was  followed  by  a  typical 
attack  characterized  by  paleness,  nausea,  vomiting, 
fainting,  a  paroxysm  of  wild  fear.  The  attack  was 
followed  by  an  hour's  sleep. 


184     Causation  and  Treatment^  Psychopathic  Diseases 

Patient  is  afraid  that  this  hematophobia  may  prove 
hereditary.  He  claimed  it  was  in  the  members  of  his 
family,  and  that  he  observed  it  in  his  little  boy  of  three. 

If  the  investigating  psychopathologist  digs  deep 
down,  by  the  various  psychognostic  methods  at  his  dis- 
posal, into  the  patient's  consciousness  and  subconscious- 
ness, so  as  to  reach  the  very  roots  of  the  symptom  com- 
plex of  psychopathic  affections,  he  invariably  finds  a 
morbid  condition  of  the  impulse  of  self-preservation 
and  a  diseased  state  of  an  intensified,  exaggerated  reac- 
tion, central  and  efferent,  of  the  fundamental  fear 
instinct,  the  psychogenesis  dating  to  events  and 
experiences  of  early  childhood. 

The  practical  physician,  to  whom  treatment  is  no  less 
important  than  causation,  psychognosis,  and  diagnosis 
of  psychopathic  maladies,  may  be  interested  to  learn 
that  almost  all  the  cases  of  the  type  reported  here  have 
been  treated  by  me  by  hypnoidization,  described  in 
^^ Symptomatology,^^  and  also  further  on  in  this  volume. 
Some  of  the  cases  were  also  treated  by  other  methods 
described  in  a  further  chapter  in  this  work. 

Most  of  the  patients,  about  seventy-five  per  cent, 
were  cured.  About  twenty  per  cent  of  the  cases  greatly 
improved.  The  remainder,  about  five  per  cent,  did 
not  respond,  on  account  of  the  short  time  of  the  treat- 
ment. 


CHAPTER  XIV 

PSYCHOGNOSIS  OF  PSYCHOPATHIC  CASES 

IT  is  by  no  means  a  matter  of  chance  that  one 
patient  should  be  a  psychosomatic  while  another 
is  a  psychoneurotic.  This  is  found,  by  a  psycho- 
genetic  examination  of  the  conscious,  and  espe- 
cially of  the  subconscious  mind,  to  depend  on  the 
character,  temperament,  and  the  whole  training  of  the 
patient,  as  well  as  on  the  nature  of  the  event  that  has 
aroused  the  slumbering  fear  instinct.  Patients  of  an 
introspective  turn  of  mind,  with  their  attention  directed 
to  mental  and  social  accomplishments,  early  trained  in 
the  rigid  school  of  religion,  morals,  and  overrefined 
social  traditions,  sensitive  to  any  deviations  from  the 
"categorical  imperatives," — the  commandments  given 
by  the  divine  trinity  of  religion,  morality,  and  society, 
as  taught  in  the  nursery,  the  Sunday  school,  and  the 
market-place, — such  patients,  when  subjected  to  experi- 
ences that  touch  their  sensibilities,  setting  the  primitive 
fear  instinct  to  work,  are  confirmed  psychoneurotics. 
Patients  who  are  not  mentally  introspective,  but  have 
their  attentions  and  fears  turned  to  their  physical  needs 
and  bodily  functions,  such  patients  are  naturally 
psychosomatics. 

From  our  present  vantage-ground  we  can  clearly 
realize  why  certain  experiences  become  subconscious 
or  dissociated  and  "present  subconsciously,"  as  the 
clinical  psychopathologist  is  apt  to  put  it.  Fear  more 
than  any  other  emotion  brings  about  the  factors  favor- 
able for  the  production  of  subconscious  states,  limita- 
tion of  voluntary  movements,  limitation  of  the  field  of 
consciousness,   monotony,   and  inhibition.     We   know 

185 


1 86     Causation  and  Treatment,  Psychopathic  Diseases 

what  a  paralyzing  effect  on  all  the  functions  of  the  body 
and  of  the  mind  fear  has.  The  man  stricken  by  the 
fear  instinct  remains  immovable,  and  his  mind  is  a  blank. 
All  ideas  except  that  of  the  danger  at  hand  are  inhibited, 
and  possibly  under  no  other  condition  is  the  factor  of 
monotony  so  operative.  All  the  factors  requisite  for 
the  production  of  subconscious  states  are  present  in 
their  full  force,  and  the  individual  falls  into  a  subcon- 
scious state,  dissociated  from  the  rest  of  waking  life. 
So  greatly  is  fear  conducive  to  the  production  of  sub- 
conscious states,  so  powerful  is  the  fear  instinct  in  its 
paralyzing  effect  on  the  waking  consciousness,  that  it 
is  often  used  as  a  means  of  bringing  about  hypnosis  and 
allied  conditions. 

In  all  creeds  of  the  "healing"  variety,  the  faith  that 
makes  their  devotees  subject  to  all  forms  of  subcon- 
scious states  depends  in  reality  upon  the  fear  instinct. 
In  the  superficial  love,  goodness,  and  optimism  of  the 
mental  and  Christian  scientist  is  hidden  the  baneful, 
the  noxious,  power  of  the  primitive  animal  fear  instinct. 
In  a  superstitious  person,  or  in  a  person  trained  in 
fear  from  early  childhood,  an  experience  conceived 
in  fear  begets  dissociation,  and,  as  such,  becomes  sub- 
conscious, giving  rise  to  the  various  forms  of  recurrent 
mental  states  of  psychopathic  maladies,  somopsychosis 
and  psychoneurosis. 

The  psychognosis  of  a  series  of  cases  are  given  here, 
obtained  in  the  investigation  of  the  etiology  and  patho- 
logical foundation  of  psychopathic  disturbances.  In 
the  study  of  these  cases  one  should  pay  attention  to 
the  underlying  processes  and  causative  agencies,  such 
as  the  impulse  of  self-preservation  with  its  instinct  of 
fear,  correlated  with  the  principle  of  variations  in  the 
expenditure  of  neuron  energy  with  consequent  mani- 
festations of  psychopathic  fatigue,  accompanied  by  its 
long  and  ever  changing  train  of  psychopathic  symp- 


Psychognosis  of  Psychopathic  Cases  187 

toms.  The  rich  kaleidescopic  display  of  psychopathic 
symptoms  is  essentially  based  on  these  three  factors, 
self-preservation,  fear  instinct,  and  variations  of  neuron 
energy. 

At  the  same  time  it  is  of  the  utmost  importance  in  the 
study  and  psychognosis  of  psychopathic  affections  to 
follow  the  action  of  the  factors  which  have  operated 
in  the  growth  and  development  of  the  psychopathic 
aggregate,  and  which  have  brought  the  latter  to  its 
present  state.  The  principles  of  the  evolution  of 
psychopathic  aggregates  will  be  understood  more 
clearly  by  direct  observation  and  psychognosis  of  con- 
crete clinical  material.  It  may  be  well  to  quote  here 
the  main  psychopathological  principles: 

I.     The  Principle  of  Embryonic  Psychogenesis. 
II.     The  Principle  of  Recurrence. 

III.  The  Principle  of  Proliferation  and  Complica- 

tion. 

IV.  The  Principle  of  Fusion  of  Synthesis. 
V.     The  Principle  of  Contrast. 

VI.  The  Principle  of  Recession. 

VII.  The  Principle  of  Dissociation. 

VIII.  The  Principle  of  Irradiation  or  of  Diffusion. 

IX.  The  Principle  of  Differentiation. 

X.  The  Principle  of  Dominance. 

XI.  The  Principle  of  Dynamogenesis. 

XII.  The  Principle  of  Inhibition. 

XIII.  The  Principle  of  Diminishing  Resistance. 

XIV.  The  Principle  of  Metathesis  and  Control  by 

Modification. 

It  is  well  to  keep  also  in  mind  the  laws  of  recession 
and  reversion,  and  the  general  tendency  of  the  process 
of  mental  degeneration. 


1 88     Causation  and  Treatment^  Psychopathic  Diseases 

A 

Male,  age  thirty-one.  Russian.  Father  is  nervous; 
mother  is  also  nervous  and  suffers  from  severe  head- 
aches, so  does  his  sister,  who  is  otherwise  quite  well. 
Physical  examination  is  negative;  reflexes  are  normal; 
memory,  attention,  recognition,  are  good;  no  sensori- 
motor disturbances. 

Patient  suffers  occasionally  from  severe  attacks  of 
headache  accompanied  by  vomiting;  he  has  depres- 
sing nightmares  and  cries  out  in  his  sleep.  He  is 
timid  and  keeps  away  from  company,  communing 
with  himself.  In  his  childhood  patient  made  the  round 
of  child  diseases.  He  is  physically  well,  but  rather 
slightly  built.  Patient  is  religious  and  has  "never 
masturbated. "  About  the  age  of  eighteen  he  developed 
contrary  thoughts  in  regard  to  God;  he  could  not  pray 
without  associating  in  his  mind  the  words  of  the  prayer 
with  filthy  words  and  curses.  Unaccountable  fears 
took  possession  of  his  mind.  At  the  same  time  sexual 
desires  became  developed,  and  his  mind  began  to  asso- 
ciate them  with  all  kinds  of  improper  relations,  even 
with  his  sister  and  with  his  mother.  He  is  miserable 
about  these  ideas,  and  the  thoughts  are  not  only  repug- 
nant to  him,  but  simply  torture  him  by  their  very 
presence.  Since  last  year  the  patient  has  become  worse, 
— his  sexual  and  contrary  religious  ideas  have  become 
more  insistent. 

The  insistent  ideas  have  gained  such  a  hold  on  the 
patient  that  he  is  distracted  with  mental  anguish,  with 
intense  pangs  of  conscience.  He  can  carry  on  the  work 
of  cigar  making  with  great  difficulty,  and  when  he  comes 
back  from  his  work,  he  sits  all  by  himself  and  is  not 
doing  anything,  avoids  company  and  keeps  on  brood- 
ing. Occasionally  he  gets  irritable,  cries  and  claims 
that  the  "evil  one"  has  gotten  possession  of  his  heart 


Psychognosis  of  Psychopathic  Cases  1 89 

and  conscience.  He  Is  suspicious  and  gets  easily  fright- 
ened. The  mental  anguish  of  the  fear  instinct  aild 
the  struggle  with  the  Insistent  "evil"  ideas  become  at 
times  so  acute  that  the  patient  is  like  one  "crazy," 
yells  and  screams  like  one  possessed.  Occasionally  he 
experiences  the  sensation  of  some  one  pulling  at  his 
clothes.  When  on  the  point  of  falling  asleep  he  hears 
"evil"  voices.  At  night,  when  on  the  point  of  waking 
up,  he  is  tortured  by  fearful  nightmares,  cries  and 
moans  before  he  can  arouse  himself,  or  be  aroused. 
Patient  wants  to  leave  the  city,  wishes  to  get  away 
from  himself,  wants  to  commit  suicide.  What  keeps 
him  back  is  his  intense  religious  belief.  The  insistent 
sexual  ideas  have  taken  such  a  hold  on  his  mind  that 
patient  is  afraid  to  remain  alone  with  his  sister  and 
even  with  his  mother. 

In  one  of  our  conversations  the  patient  was  asked 
the  reason  why  he  troubled  himself  about  the  thoughts 
when  he  was  fully  conscious  that  they  were  but  "  non- 
sense," he  replied:  "I  cannot  help  it;  my  head  gets  de- 
pressed and  heavy;  I  should  prefer  to  be  in  hell  than 
to  have  this  kind  of  nonsense.  When  I  have  these 
ideas  my  head  Is  dark;  all  looks  dark.  When  I  attend 
to  my  natural  wants  I  think  of  God  and  associate  Him 
with  It  to  anger  Him.  When  I  spit,  for  instance,  I  can- 
not help  thinking  T  spit  on  God'." 

Patient  has  bad  nightmares.  He  feels  that  some- 
thing is  lying  on  him  and  pressing  him;  he  is  afraid  of 
death.  He  has  his  eyes  open,  but  he  cannot  move. 
On  falling  asleep,  or  rather  when  he  finds  it  difficult  to 
fall  asleep,  he  can  hear  voices  distinctly.  The  voices 
talk  to  him  as  one  man  to  another;  he  cannot  remember 
what  the  voices  say.  He  can  hear  the  voices  near  the 
ear,  not  inside.  When  patient  walks  in  the  street 
"dreams  come  to  him,"  then  he  seems  to  wake  up  and 
does  not  remember  anything.     When  he  goes  to  bed  he 


190     Causation  and   Treatment,  Psychopathic  Diseases 

talks  to  himself,  and  is  even  conscious  that  he  answers 
questions.  When  he  wakes  he  is  sometimes  under  the 
impression  that  the  "evil  one"  has  gotten  a  firm  hold 
on  him.  There  is  some  one,  the  evil  one,  who  laughs 
and  jeers  at  him. 

When  a  boy  of  fifteen,  he  used  to  have  vivid 
dreams,  could  hear  steps  of  "spirit  people"  in  the  room. 
He  used  also  to  be  frightened  by  shadows,  a  fear  which 
dates  far  back  to  his  early  childhood.  When  about  the 
age  of  twenty,  he  was  tantalized  by  the  idea  of  death, 
though  not  of  suicide,  represented  to  himself  the  angel 
of  death  very  clearly,  and  "the  fear  made  him  feel 
faint. "  Last  summer,  to  counteract  the  sexual  thoughts 
and  excitement,  he  attempted  (on  the  principle  of  meta- 
thesis) to  revive  the  image  of  the  angel  of  death  in 
order  to  feel  faint,  but  he  did  not  succeed. 

About  six  years  ago  patient  worked  on  the  sewing 
machine;  one  day  he  suddenly  lost  the  power  of  move- 
ment in  the  legs.  This  paralysis  lasted  three  days. 
He  improved  and  went  to  his  work.  Two  years  ago 
patient  suddenly  lost  the  use  of  the  right  hand  and 
right  leg.  It  was  not  so  much  an  actual  paralysis  as  an 
intense  pain  In  moving  the  leg  and  hand.  He  could 
not  raise  the  elbow  and  dragged  the  leg.  This  lasted 
from  April,  19CXD,  to  February,  1901.  A  year  ago  a 
young  girl  came  to  visit  the  family  and  was  placed  to 
sleep  in  the  adjoining  room.  This  developed  an  intense 
sexual  excitement,  with  thoughts  of  sexual  character. 
When  this  fear  developed,  the  pain  and  paralysis 
ceased.  One  fear  was  substituted  for  the  other  (on  the 
principle  of  metathesis).  The  sexual  thoughts  are  ac- 
companied with  "burnings"  which  cause  the  patient 
great  sufferings.  These  thoughts  come  periodically. 
The  evil  and  "nonsense"  thoughts  are  almost  always 
present  and  give  him  no  rest. 


Psychognosis  of  Psychopathic  Cases  191 

Patient  feels  dazed;  does  not  know  where  he  is,  what 
he  is  doing,  whether  he  lives  at  all.  Everything  is"  like 
nonsense."  His  hypnagogic  and  hypnapagogic  halluci- 
nations consist  of  ugly  faces  without  hands  and  feet  and 
of  other  grotesque  visions.  The  insistent  ideas  are 
somewhat  like  "voices," — they  call  him  names,  they 
laugh  and  jeer  at  his  religious  beliefs,  at  all  that  he 
regards  as  moral  and  sacred.  He  feels  that  there  is 
another  person  in  him  that  instills  in  his  mind  those 
evil  ideas  against  everything  that  is  holy.  The  more 
he  fights  the  more  that  evil  person  confuses  his  thoughts 
with  "unholy  ideas,"  and  finally  even  paralyzes  his 
body.  Patient  can  read  well  "profane  writings,"  such 
as  newspapers,  novels,  but  a  religious  book,  and  espe- 
cially the  scriptures,  awaken  in  him  the  evil  one  who 
makes  him  suffer  untold  agonies,  intolerable  pangs  of 
conscience. 

I  may  add  the  following  interesting  letter  written  to 
me  by  the  patient: 

"I  give  a  short  account  of  my  life  so  as  to  help 
you  to  form  an  idea  of  my  condition.  I  hope  you  will 
pardon  me  for  putting  you  to  so  much  trouble. 

"In  my  early  childhood  and  youth  I  suffered  a  good 
deal  and  many  times  I  had  to  go  without  food.  When 
I  was  about  fourteen,  I  lost  two  brothers,  one  younger 
and  one  older  than  myself.  The  younger  brother,  a  boy 
of  three,  I  used  to  take  care  of  and  instructed  him.  I 
loved  him  more  than  my  own  life.  Besides,  my  parents 
were  at  that  time  in  very  poor  circumstances.  I  was 
greatly  upset  and  felt  deprived  of  bodily  and  mental 
strength. 

"I  began  at  that  time  to  learn  the  trade  of  jeweler, 
but  as  my  mind  was  weak  I  could  not  do  the  work, 
and  after  ten  months  of  great  suffering  I  fell  sick  and 
had  to  give  up  the  work  altogether. 

"I  then  obtained  a  position  as  clerk  in  a  small  store 


192     Causation  and   Treatment^  Psychopathic  Diseases 

and  had  trouble.  You  can  see,  therefore,  that  up  to  the 
time  of  my  coming  to  this  country  I  have  suffered 
greatly  and  still  continue  to  suffer. 

"I  shall  now  describe  the  silly,  evil  thoughts  that 
torment  me  so  fearfully. 

"When  I  was  eighteen  years  old  it  suddenly  occurred 
to  me  to  curse  the  Creator.  The  curses  were  awful. 
Since  then  my  personality  has  changed.  Confusion 
came  into  my  mind.  Evil  thoughts  got  hold  of  me. 
I  began  to  substitute  contrary  sentences;  thus,  instead 
of  'The  earth  is  full  of  His  glory,'  I  substituted  'The 
earth  is  full  of  his  filth.'  During  prayer  these  thoughts 
would  come  to  me.  The  most  indecent,  filthy  thoughts 
would  come  to  torment  me.  I  would  cry  for  hours  and 
struggle  against  them,  but  of  no  avail.  The  more  I 
tried  to  drive  those  thoughts  from  my  mind,  the  more 
persistent  and  unholy  would  they  become.  Since  then 
I  have  become  depressed  and  melancholy.  I  have  lost 
all  desire  for  life.  I  feel  as  if  I  would  like  to  go  into  a 
desert  and  there  die.  I  want  to  live  and  have  a  quiet, 
undisturbed  mind.  I  am  a  human  being;  I  cannot 
hide  myself.  I  have  eyes  and  ears,  but  everything  I 
see  and  hear  is  transformed  into  evil. 

"  I  cannot  undertake  to  describe  all  the  bad  thoughts 
that  enter  into  my  mind.  If  you  could  drive  all  this 
nonsense  from  my  mind  without  weakening  my  love 
for  my  people  or  my  religion,  if  you  could  bring  it  about 
that  I  could  read  the  Bible  without  changing  the 
thoughts  into  evil,  and  my  mind  should  be  clear  of  horri- 
ble fears,  you  would  save  my  life.  Oh!  if  light  should 
dawn  upon  me  and  my  mental  darkness  should  disap- 
pear! 

"I  have  confessed  to  you  everything,  more  than  I 
would  to  my  father  and  mother. " 

The  condition  of  this  case  can  be  understood  in  the 
light  of  the  patient's  childhood,  revealed  by  means  of 


Psychognosis  of  Psychopathic  Cases  ,193 

various  intermediary  states,  and  by  indirect  inquiry 
of  the  patient's  parents  and  sister.  The  patient 
passed  his  childhood  and  youth  in  extreme  poverty 
and  misery,  in  the  midst  of  social,  political,  and  reli- 
gious oppressive  fears.  Living  from  his  very  babyhood 
in  misery,  extreme  poverty,  and  squalor,  often  endur- 
ing cold  and  the  pangs  of  hunger,  surrounded  by 
disease,  sufferings,  pains  due  to  starvation,  affected  by 
sickness  and  death  of  those  near  and  dear  to  him,  the 
patient,  with  all  his  natural  intelligence,  had  been 
fostered  in  the  strict  religious  belief  of  a  fearful  Provi- 
dence. With  all  his  needs,  desires,  and  instincts,  thwart- 
ed and  mocked  at  by  the  merciless  conditions  of  life, 
subconscious  protests  began  gradually  to  form  by  prin- 
ciple of  contrast;  the  protests,  gathering  force,  finally 
burst  forth  with  the  crisis  of  adolescence.  It  was  a 
protest  of  subconscious  mental  activity  against  a  life 
of  misery,  hallowed  by  a  religion  of  fear. 

Out  of  the  chaos  of  discordant,  dissociated  elements 
we  see  the  formation  of  an  ill-shaped,  maimed,  but 
defiant,  subconscious,  secondary  personality  of  nihilistic 
tendencies, — a  state  through  which  his  country  and 
countrymen  are  now  passing.  We  witness  here  a 
struggle  full  of  anguish  and  agony  of  fear  between  a 
shattered  personality  and  a  newly-forming  self  out  of 
a  chaotic,  disaggregated  subconsciousness. 

Like  the  demoniacal  possession  of  the  Middle  Ages, 
it  is  the  reading  of  the  sacred  scriptures  that  throws 
the  patient  into  a  condition  of  distress  and  of  inner 
combat  of  discordant  elements.  The  patient  is  not 
fully  aware  of  the  why  and  wherefore  of  the  "pangs 
of  his  conscience,"  but  still  he  seems  to  have  some  dim 
suspicion  of  the  nature  of  his  malady,  when  he  asks  for 
help  "without  weakening  my  love  for  my  people  and 
my  religion. "  The  patient's  condition  is  the  agony  of 
a  mortally  wounded  self  struggling  against  the  merci- 


194     Causation  and   Treatment,  Psychopathic  Diseases 

less  onslaughts  of  a  pitiless,  secondary  self  formed  out 
of  chaotic  states  of  a  disaggregated  subconsciousness, — 
the  struggle  of  a  terrorized  animal. 

In  all  such  cases  we  find  the  workings  of  the  impulse 
of  self-preservation  and  the  fear  instinct,  having  a  dis- 
aggregating influence  on  the  human  personality. 


B 

Mr.  D.,  a  young  man  of  twenty-five,  born  in  Poland. 
As  far  as  can  be  ascertained,  the  parents,  as  well  as 
the  brothers  and  sisters,  are  well.  A  physical  exami- 
nation of  the  patient  reveals  nothing  abnormal.  There 
are  no  sensory,  no  motor  disturbances.  He  complains 
of  severe  headaches,  preceded  by  a  feeling  of  indisposi- 
tion, depression,  vertigo,  and  distress.  During  the 
attack  there  is  hyperesthesia  to  touch,  pressure,  tem- 
perature, and  to  visual  and  auditory  stimulations. 
The  patient  shivers  and  looks  pale.  The  cold  experi- 
enced during  the  attack  is  so  intense  that  the  patient 
has  to  wrap  himself  in  many  blankets,  as  if  suffering 
from  a  malarial  paroxysm. 

Fears  have  strong  possession  of  the  patient's  mind. 
He  is  afraid  to  remain  in  a  closed  place  in  the  daytime 
and  especially  at  night.  When  he  has  to  remain  alone 
at  night,  he  is  in  agony  of  fear,  and  cannot  go  to  sleep. 
Every  passer-by  is  regarded  as  a  robber  or  murderer, 
and  he  quakes  at  the  least  noise.  When  walking  in 
the  house  in  the  dark,  he  has  the  feeling  as  if  some  one 
were  after  him,  and  occasionally  even  experiences  the 
hallucination  of  some  one  tugging  at  his  coat.  He  is 
mortally  afraid  of  the  dead  and  shuns  a  funeral.  The 
patient  has  also  a  fear  of  dogs,  a  cynophobia.  The 
fear  is  irresistible  and  is  as  involuntary  as  a  reflex. 


Psychognosis  of  Psychopathic  Cases  195  . 

An  investigation  by  means  of  the  hypnoidal  states, 
brought  out  of  the  patient's  subconscious  life  the  fol- 
lowing data: 

When  a  child  of  three  years,  the  patient  lived  with  his 
family  in  a  small  village  near  a  large  forest  infested 
with  wolves.  In  one  of  the  intermediary  states  a 
faint  memory,  rather  to  say  a  vision,  struggled  up, — 
a  vision  of  wolves  and  dogs.  Some  one  cried  out: 
"Run,  wolves  are  coming!"  Crazed  with  fear,  he  ran 
into  the  hut  and  fell  fainting  on  the  floor.  It  turned 
out  to  be  dogs  instead  of  a  pack  of  wolves.  It  is  that 
fright  in  early  childhood  which  has  persisted  in  the  sub- 
conscious mind,  and,  having  become  associated  with 
subsequent  experiences  of  attacks  of  dogs,  has  found 
expression  in  the  patient's  consciousness  as  an  instinc- 
tive fear  of  dogs. 

But  why  was  the  patient  in  such  abject  terror  of 
dead  people .?  This  found  its  answer  in  the  experiences 
and  training  of  his  early  life.  When  a  young  child,  the 
patient  heard  all  kinds  of  ghost  stories  and  tales  of 
wandering  lost  souls  and  of  spirits  of  dead  people 
hovering  about  the  churchyard  and  burial  grounds; 
he  heard  tales  of  ghouls  and  of  evil  spirits,  inhabiting 
deserted  places,  dwelling  in  the  graves  of  sinners  and 
the  wicked.  He  listened  to  stories  of  haunted  houses 
and  of  apparitions  stalking  about  in  the  dark.  His 
social  and  religious  environment  has  been  saturated 
with  the  belief  in  the  supernatural,  as  is  usually  the 
case  among  the  superstitious  populations  of  Eastern 
Europe.  We  cannot  wonder,  then,  that  an  impression- 
able child  brought  up  under  such  conditions  should 
stand  in  mortal  fear  of  the  supernatural,  especially  of 
the  dead. 

When  the  patient  was  about  nine  years  old,  his 
parents  noticed  some  prominences  on  his  right  chest. 
It  was  suggested  to  them  that  the  hand  of  a  dead  per- 


196     Causation  and  Treatment,  Psychopathic  Diseases 

son  possessed  the  property  of  blighting  life  and  of 
arresting  all  growth,  and  would  therefore  prove  a 
"powerful  medicine"  for  undesirable  growths.  It 
happened  that  an  old  woman  in  the  neighborhood  died. 
The  little  boy  was  taken  into  the  room  where  the  dead 
body  was  lying,  and  the  cold  hand  of  the  corpse  was 
put  on  the  child's  naked  chest.  The  little  fellow 
fainted  away  in  great  terror.  The  fear  of  dead  people 
became  subconsciously  fixed  and  manifested  itself  as 
an  insistent  fear  of  the  dead,  and,  in  fact,  of  anything 
connected  with  the  dead  and  the  world  of  spirits. 

The  patient  had  hardly  recovered  from  the  shock 
of  the  "dead  hand"  when  he  had  to  pass  through  a 
still  more  severe  experience.  A  party  of  drunken 
soldiers  stationed  in  the  little  town  invaded  his  house 
and  beat  his  father  unmercifully,  almost  crippling  him; 
they  knocked  down  his  mother,  killed  a  little  brother 
of  his,  and  he  himself,  in  the  very  depth  of  a  winter 
night,  dressed  in  a  little  shirt  and  coat,  made  his  escape 
to  a  deserted  barn,  where  he  passed  the  whole  night. 
He  was  nearly  frozen  when  found  in  the  morning, 
crouching  in  a  corner  of  the  barn,  shivering  with  fear 
and  cold. 

From  that  time  on  the  headaches  manifested  them- 
selves in  full  severity,  with  hyperesthesia  and  deathlike 
paleness  and  intense  cold  of  the  body. 

The  early  cultivation  of  the  fear  instinct  resulted  in 
a  psychoneurosis  with  its  recurrent  states. 


Mrs.  M.  M.,  Armenian,  AIntab,  age  27,  medical  stu- 
dent; married,  but  divorced  six  years  ago;  has  child 
by  marriage.  Last  March  (191 3)  had  a  serious  attack 
of  diphtheria:  then  about  eight  weeks  had  a  lapse  of 


Psychognosis  of  Psychopathic  Cases  197 

personality,  patient  does  not  know  where  she  is,  does 
not  recognize  her  face.  Suffered  from  insomnia,  had 
to  take  bromides;  has  shaking  spells.  Worked  hard  as 
interne,  worried  about  child,  about  the  work,  about  the 
future.  Was  very  religious.  Afraid  of  insanity;  dreams 
of  her  morbid  condition.  Used  to  be  afraid  of  the  dark, 
of  robbers,  afraid  of  her  face,  cannot  associate  it  with 
herself,  had  to  look  at  herself  to  make  sure  that  she  was 
herself.  One  day  was  looking  into  a  mirror  to  make 
sure  of  herself;  a  sudden  attack  of  fright,  did  not  know 
of  what;  had  various  fears  at  the  age  of  ten.  The  attacks 
of  fear  occur  about  two  or  three  times  a  week,  afraid 
to  remain  alone.  Suffers  from  headache,  nervous  chills, 
noises  in  the  ear. 

The  patient  gives  the  following  account: 

"During  the  last  six  years  great  deal  of  fear  of  kid- 
napping of  the  child  by  his  father — hard  work  nursing 
all  summer  and  going  to  school  and  during  school 
terms  working  for  board  and  room — no  vacation  during 
all  this  time  (six  years)  and  great  deal  of  anxiety  during 
the  trial  of  separation  and  divorce  case. 

"Present sickness: Diphtheria — first  of  March — days 
in  bed — no  antitoxin  given,  because  was  vaccinated  for 
smallpox  twelve  days  previous  to  attack." 

Complication,  myocarditis,  nervous  prostration. 

"Had  two  days  rest  at  home  after  the  discharge  from 
hospital  and  went  back  to  school.  Began  to  have 
dyspnoea,  palpitation,  tremors  of  the  hands  and  feet, 
pulsation  of  superficial  vessels,  headaches,  buzzing  and 
ringing  in  the  ears,  vertigo,  nervous  discharge  which 
seemed  to  depress  and  crush  the  brain  and  extend 
over  the  spine,  and  which  caused  a  kind  of  dazed 
feeling  for  a  few  seconds,  then  disappeared,  termi- 
nating in  a  cold  perspiration.  These  attacks  came  on 
mostly  after  lectures;  and  had  one  or  two  a  day.  In 
this  condition  continued  school  for  two  weeks;  at  the  end 


198     Causation  and  Treatment,  Psychopathic  Diseases 

of  this  period  one  day  at  the  lecture  had  this  attack,  but 
seemed  as  though  was  not  able  to  use  the  right  hand, 
tried  to  write,  but  was  not  able  to  hold  pen,  tried 
to  walk,  but  was  too  weak,  it  seemed  as  though  had 
eight  feet — was  taken  away  from  lecture  room  and 
given  some  heart  stimulant,  then  put  to  bed.  At  the 
end  of  half  an  hour  had  one  more  of  those  attacks, 
this  time  it  seemed  as  though  the  right  side  of  the 
body  was  helpless,  it  seemed  like  passing  away,  dying, 
was  not  able  to  speak  for  two  to  three  minutes  but 
didn't  last,  at  the  end  of  a  few  minutes  dyspnoea  grew 
very  much  worse  and  also  dizziness; — was  sure  it  was 
the  last  moment  of  life. 

"After  a  while  hands  and  feet  were  ice  cold  and 
then  came  a  chill  just  like  an  extremely  bad  malarial 
chill.  It  seemed  as  though  all  the  bones  would  break  or 
dislocate  by  shaking,  the  chill  lasted  twenty-five 
minutes,  terminating  with  cold  perspiration  and  dis- 
charge of  great  quantities  of  urine;  during  the  at- 
tack was  very  frightened.  After  this  attack  was  in 
bed  two  weeks;  had  four  or  five  more  attacks  similar 
to  this  one,  but  very  mild. 

"During  these  two  weeks  was  not  able  to  write  or 
talk  for  any  length  of  time,  was  very  much  depressed, 
was  sure  was  not  going  to  live,  and  was  making  prep- 
arations for  death.  Had  a  very  bad  headache — some- 
times continuous  contraction  and  relaxation  of  all  the 
muscles  for  two  or  three  minutes.  Noises  in  the  ears. 
Spasm  of  muscles  of  mastication  and  of  the  muscles  of 
the  right  eye,  and  symptoms  of  nervous  prostration. 
The  third  week  grew  better  and  went  back  to  school. 
"On  my  third  day  at  school  left  the  room  to  go  to 
school,  suddenly  became  dizzy,  it  seemed  as  though  I 
was  wrapped  in  a  black  cloud,  and  separated  from  all 
the  world,  was  completely  lost  to  my  surroundings. 
I  then  became  stronger  and  stronger,    it  seemed   as 


Psychognosis  of  Psychopathic  Cases  199 

though  I  went  away  from  this  world  and  left  my  body 
behind.  I  was  not  able  to  decide  where  I  was  or  who 
I  was;  then  this  question  came  to  my  mind,  "I  wonder 
where  I  am.'  'Am  I  dead  and  is  this  the  second  life?' 
'Was  it  a  true  fact  that  I  have  been  sick  and  dead  and 
this  is  another  stage  of  life?'  'Am  I  in  Philadelphia  or 
somewhere  else?'  'Is  this  my*own  home?'  'Are- these 
my  own  hands?'  'Is  this  my  own  dress.?'  'Yes,  I  can 
remember  where  I  bought  this  dress  and  these  shoes 
so  there  must  be  something  true  about  me,  but  where 
is  my  own  self?  What  happened  to  me?  Something 
went  away  from  me,  what  was  it?  Was  it  my  own 
soul  or  the  thing  we  call  self  or  personality?  Where  is 
my  room — I  must  try  to  find  it. " 

Intense  fear  of  loss  of  surroundings  and  fear  of  loss 
of  personaHty  are  at  the  basis  of  the  symptom  complex. 
A  morbid  impulse  of  self-preservation  and  the  fear 
instinct  form  the  pathology  of  the  case. 

D 

I 

Patient  is  physically  well  developed;  a  well  known 
professor  of  physics  in  one  of  the  foremost  institutions 
in  this  country.  He  suffers  from  attacks  of  loss  of 
personality.  The  attack  is  of  a  periodical  character, 
coming  on  at  intervals  of  two  weeks,  occasionally  dis- 
appearing for  a  few  months,  then  reasserting  itself  with 
renewed  energy  and  vigor.  During  the  attack  the 
patient  experiences  a  void,  a  panic,  which  is  sudden  in 
its  onset,  like  petit  mal.  The  trouble  was  diagnosed  as 
larval  or  psychic  epilepsy;  the  patient  was  referred  to 
me  by  Dr.  Morton  Prince  as  an  interesting,  but  puz- 
zling case. 

Patient  feels  that  his  "self"  is  gone.     He  can  carry 
on  a  conversation  or  a  lecture  during  the  attack,  so 


200     Causation  and  Treatment,  Psychopathic  Diseases 

that  no  outsider  can  notice  any  change  in  him,  but  his 
self  is  gone,  and  all  that  he  does  and  says,  even  the 
demonstration  of  a  highly  complex  problem  in  integral 
calculus  is  gone  through  in  an  automatic  way.  The 
fury  of  the  attack  lasts  a  few  moments,  but  to  him 
it  appears  of  long  duration.  He  is  ''beside  himself," 
as  he  puts  it.  He  seems  to  stand  beside  himself  and 
watch  his  body,  "the  other  fellow,"  as  he  describes  it, 
carry  on  the  conversation  or  the  lecture.  "He  is 
knocked  out  of  his  body,  which  carries  on  all  those 
complicated  mental  processes."  For  days  after  he 
must  keep  on  thinking  of  the  attack,  feels  scared  and 
miserable,  thinking  insistently,  in  great  agony,  over 
his  awful  attack,  a  recurrent,  psychoneurotic  phreno- 
phobia. 

At  first  the  patient  could  trace  this  attack  only  as 
far  back  as  his  seventh  year.  Later  on,  earlier  experi- 
ences of  childhood  came  to  light,  and  then  it  became 
clear  that  the  attack  developed  out  of  the  primitive,  instinc- 
tive fear  of  early  childhood,  fear  of  the  unfamiliar,  fears 
of  the  dark,  of  the  unknown,  of  the  mysterious,  to  which 
he  had  been  subjected  in  his  tender  years.  This  state 
was  further  reinforced  by  the  early  death  of  his  parents, 
it  was  hammered  in  and  fixed  by  hard  conditions  of  life, 
full  of  apprehension  and  anxiety.  Life  became  to  the 
child  one  big  mysterious  fear  of  the  unknown.  The 
fear  instinct  formed  the  pathological  focus  of  the  at- 
tack. As  the  patient  puts  it:  "It  is  the  mystical  fear 
of  the  attacks  which  overpowers  me." 

With  the  disintegration  of  the  focus  the  symptom 
complex  of  the  attacks  disappeared.  The  patient  is 
in  excellent  condition,  he  is  doing  brilliant  research 
work  in  physics  and  chemistry. 

T  give  extracts  from  my  clinical  notes  of  the  case: 


Psychognosis  of  Psychopathic  Cases  2CI 

D 
11 

H.  T.  K.,  twenty-five,  married.  Father  died  of 
Bright's  disease.  Mother  died  of  appendicitis.  Only 
child.  At  age  of  seven  walking  down  street  with  uncle, 
things  and  persons  became  suddenly  peculiar.  The 
attacks  seem  to  date  from  that  time.  During  the  brief 
attack  patient  can  keep  on  with  his  work,  the  senses  are 
not  affected.  It  seems  as  if  life  is  gone,  it  is  a  sort  of 
emotional  attack.  Intellectual  activity  goes  on.  At 
the  age  of  thirteen  began  to  have  attacks  very  hard. 
Fixed  ideas  of  having  "narrow  shoulders  at  seventeen." 
This  lasted  about  six  months. 

The  attack  lasts  about  a  fraction  of  a  second.  Feel- 
ing of  fear.     Keeps  on  thinking,  "what  am  IV^ 

Between  attacks  has  the  feeling  of  fear,  does  not 
know  of  what.  Has  been  treated  for  years  in  the  city 
hospital.  Physicians  regarded  attacks  as  petit  mal, 
and  treated  him  for  epilepsy. 

Under  Von  Monakov  in  Zurich  winter  of  1905. 

Janet  in  Paris  spring  of  1906. 

Then  Prince  and  others  fall  of  1906,  1907. 

September  6,  1908.  Hypnoidal  state:  patient  very 
quiet.  Remembers  that  when  about  age  of  four  in 
school  was  excited,  and  was  afraid  when  teacher  called 
him  out. 

Patient  remembers  distinctly  walking  with  his  uncle; 
electric  lights  shining,  then  all  appeared  queer.  Was 
always  afraid  of  the  dark.  At  waterfall  in  New  Hamp- 
shire, he  was  about  this  time  riding  in  carriage  in 
the  daytime.  Old  grandmother  was  afraid  of  railroad 
tracks  and  he  was  worked  up,  suffered  mentally. 
During  the  walk  that  he  had  with  his  uncle  some  such 
feeling  came  about.     During  the  same  visit  had  met 


202   Causation  and   Treatment,    Psychopathic  Diseases 

a  hermit  who  scared  him.  Remembers  suddenly  that 
a  little  child  died  there  by  being  lost  in  snow  storm. 
Saw  the  grave.  This  happened  when  he  went  up 
Mount  Washington. 

Remembers  distinctly  that  he  was  much  excited 
when  he  was  about  four.  Had  to  imitate  the  teacher, 
did  not  know  whether  he  would  be  able  to  recite. 
Kept  on  asking  himself  whether  he  could  do  the  things. 
Since  that  time  used  to  put  himself  questions  whether 
he  was  able  to  accomplish  certain  acts,  such  as  swal- 
lowing. 

Once  patient  went  to  father  and  said,  "Papa,  I  am 
afraid."  ''Afraid.?  Of  what.?"  asked  his  father.  Did 
not  know  of  what. 

When  his  father  sent  him  on  a  dark  night  to  drug 
store,  patient  had  the  fear  of  loss  of  personality.  Kept 
the  fear  to  himself.     Always  got  that  feeling. 

Was  afraid  of  unreal  things,  fear  of  ghosts.  Does 
not  remember  whether  he  had  fear  of  darkness  before 
age  of  seven. 

Patient  eight  years  when  mother  died;  he  remembers 
his  mother's  death.  He  knew  his  mother  was  dead. 
Sat  on  steps  the  whole  day  while  mother  was  in  coffin; 
was  much  frightened. 

Patient  finds  that  in  his  spontaneous  hypnoidal 
states  after  meal  or  when  going  to  sleep,  he  can  remind 
himself  of  these  experiences:  Went  to  see  a  play,  "The 
Fall  of  Pompeii,"  picture  of  the  lava  overcoming  the 
people.  This  experience  stands  now  out  clear  and 
distinct  in  memory.  Next  is  seeing  some  tragedy; 
remembers  father  and  mother  cried  over  the  fate  of 
the  heroine.  After  these  experiences  had  his  attacks. 
The  experiences  were  frightful. 

In  one  of  his  hypnoidal  states  patient  emphasizes  the 
feeling  of  something  that  is  worrying,  something  that 
he  must  think  of.     He  has  this  feeling  every  time;  he 


Psychognosis  of  Psychopathic  Cases  203 

must  think  of  something  awful,  and  then  the  some- 
thing indefinable,  unknown  melts  away,  the  fear  and 
the  crises  set  on. 

Patient  went  into  deep  hypnoidal  state  with  shiver- 
ing, kept  on  shivering,  could  not  answer  questions. 

September  12.  Has  anxious  feeling,  begins  to  think 
of  something.  Has  feeling  of  something,  trying  to 
remember,  of  something  forgotten  which  gradually 
passes  into  loss  of  personality. 

He  thinks  that  on  the  average  the  good  period  lasts 
ten  days.  Has  indefinite  tantalizing  feeling,  feeling  of 
unreality. 

I  put  him  in  a  deep  hypnoidal  state.  Intense  fright, 
shivering.  Respiration  became  heavy,  rapid,  the  whole 
body  is  hypoaesthetic,  could  not  catch  his  breath.  Sees 
red  light.  "Something  is  going  to  happen  to  me,  I 
would  like  it  should." 

Sees  flickering  lights,  bright  lights  with  dark  spots. 
Suddenly  memory  came,  long  forgotten.  Mother  and 
grandmother  used  to  give  him  piano  lessons,  went  to 
attic,  before  going  to  bed  saying  his  prayers,  scared  in 
the  dark. 

Father  used  to  make  him  play  alone  in  dark  room. 
Patient  was  afraid  to  remain  alone.  This  memory  came 
to  him  suddenly. 

September  14.  Begins  to  feel  as  if  he  wants  to  in- 
duce the  attack  so  as  to  be  sure  that  it  is  weakened. 
Last  night  worked  in  laboratory,  turned  out  lights, 
just  as  he  came  out  had  hallucination  of  grizzly  man, 
who  had  an  awful  face,  small  in  stature,  all  grizzly  and 
crusty.  As  if  he  came  from  another  planet.  Fears 
not  earthly,  but  supernatural  things.  This  is  a  repro- 
duction of  a  child  fear. 

Another  experience  (September  12):  At  night  when 
going  from  bed  to  bath  idea  came:  "Don't  go!  it 
will  be  fatal!"     This  is  another  of  his  child  fears. 


204     Causation  and  Treatment,  Psychopathic  Diseases 

September  14.  Went  into  hypnosis,  the  whole  body 
became  sensitive.     Respiration  irregular. 

Later  on  (after  he  woke  up)  said  he  remembered 
(though  he  knew  before)  an  old  man  he  visited  in  the 
mountains,  a  hermit.  "That  (he  said)  might  have  had 
to  do  with  the  hallucination  of  a  grizzly  man. " 

September  17.  Had  attack  on  the  fourteenth,  it 
keeps  on  again  and  again,  coming  on  when  he  gives 
up  his  work;  it  is  like  something  he  has  to  remember. 
Something  forces  him  to  think,  'what  am  I?" 

In  hypnoidal  state  he  remembers  went  up  hill  with  his 
father;  was  very  small;  had  same  feeling  of  fear  of  loss 
of  self.  Does  not  remember  whether  it  was  night  or 
day. 

Since  the  hallucination  of  the  old  man  patient  is 
afraid  to  remain  alone  in  the  laboratory. 

He  knows  he  was  very  sensitive  as  a  child,  much 
frightened  when  he  saw  the  waterfall.  The  waterfall 
looked  awful;  patient  was  scared,  "hair  standing  on 
end."  Walked  up  a  great  flight  and  looked  down 
(idea  came  suddenly).  Patient  was  appalled,  it  looked 
supernatural.  His  father  was  nervous,  and  he  was 
excited  when  he  saw  his  father. 

Dates  the  frequent  oncoming  of  his  attacks  to  time 
when  he  and  his  wife  were  in  Berlin;  he  and  she  played 
tennis,  suddenly  she  fell  down,  she  had  hallucination 
of  her  lost  brother.  Patient  became  frightened  and 
had  many  attacks  since. 

September  19.  Feels  miserable;  has  attacks  quite 
often;  feels  as  if  he  was  in  a  strange  country;  may  have 
five  to  ten  of  fear  attacks  in  an  hour. 

Hypnoidal  state  induced  by  pressure  on  carotids. 
After  a  few  minutes,  memory  emerged.  Walking 
in  back  alley;  was  frightened;  memory  is  vague.  Back 
of  the  house  was  high  fence;  thinks  he  had  his  first 
attack  near  that  fence,  someone  might  have  chased  him. 


Psychognosis  of  Psychopathic  Cases  205 

Did  not  know  it  before.  This  experience  flashed  upon 
his  mind,  cannot  get  the  details.  Some  boys  chased 
him,  drove  him  to  cHmb  fence,  frightened,  had  attack. 
Sees  pictures  distinctly. 

Remembers  he  was  a  little  fellow,  then  heard  some- 
thing strike  the  floor,  thought  lost  a  bone;  was  fright- 
ened; sink  over  his  head,  must  have  been  about  five. 

September  21.    Patient  had  attack  of  short  duration. 

Hypnoidal  state,  by  pressure  on  carotids;  felt  calm, 
but  soon  told  me  he  had  an  attack,  "saw  himself  beside 
himself. "     Attack  of  short  duration. 

Patient  was  in  hypnoidal  state.  Suddenly  told  me 
"that  back  yard  keeps  on  coming,"  "can  see  myself 
in  the  back  yard,  blind  alley,  something  bad;  afraid, 
does  not  know  of  what,  I  can  see  it  clearly. " 

Thinks  that  the  New  Hampshire  experience  and  the 
"Fall  of  Pompeii"  laid  the  foundation  of  his  attacks 
but  bicycle  ride  experience  was  much  stronger.  This 
attack  came  like  from  a  clear  sky;  attack  passed  off  as 
soon  as  he  came  home.  Bicycle  ride  took  place  about 
ninth  year.  Patient  had  been  riding  to  South  Fram- 
ington;  had  been  riding  the  whole  day;  was  afraid  his 
father  would  worry;  would  look  for  him  at  the  police 
station.  Then  he  was  afraid  to  go  away  far.  The 
attack  came  on,  then  repeated  itself  a  few  times.  That 
was  after  the  uncle  experience. 

Patient  thinks  that  this  uncle  experience  was  because 
patient  was  away  from  home  at  night.  It  was  raining, 
saw  row  of  lights,  things  appeared  to  him  queer,  dizzi- 
ness. Anything  brilliant,  anything  strange  will  affect 
him  that  way.  Coney  Island,  St.  Louis  Exposition 
brought  attacks. 

New  Hampshire  experience  was  about  the  time  the 
patient  went  to  kindergarten.  He  was  in  grammar 
school  about  seven  years  old.  Patient  has  letter  which 
he  wrote  after  New  Hampshire  experience.     He  clearly 


2o6     Causation  and  Treatment^  Psychopathic  Diseases 

remembers  the  experience  of  the  ride  and  of  his  fright; 
nothing  stands  out  so  sharp  in  his  Hfe. 

"It  is  like  one  nagging,"  he  must  think  of  some- 
thing, does  not  know  what;  loss  of  feeling  of  reality. 

From  October  to  February,  patient  is  getting  fewer 
attacks,  but  occasionally  gets  a  prolonged  one,  with 
short  ones  following. 

November  8,  1908.  In  hypnoidal  state  suddenly 
came  to  him  that  when  he  was  about  four,  thought 
about  not  being  able  to  read  in  school  (kindergarten). 
Greatly  affected.  Ran  home,  something  happened. 
Thinks  first  attack  happened  then. 

In  hypnoidal  state,  it  suddenly  appeared  to  him  that 
he  was  told  that  about  the  age  of  four  he  was  buried 
alive;  does  not  remember  it  though;  but  it  occurred  to 
him  now.  Added  that  this  might  be  connected  with 
the  fact  that  the  worst  thing  with  him  is  the  feeling  of 
being  smothered  alive. 

Patient  has  attacks  when  in  the  dark  (going  to  sta- 
tion) or  in  light  (when  playing  piano.)  Solitude  may 
bring  this  on.  When  interested  in  problems,  enthusi- 
astic in  work,  when  reserve  energy  comes  out,  attacks 
disappear. 

Thinks  that  under  given  circumstances  can  induce 
an  attack.  When  eight  to  nine  years,  going  down  the 
street  (dark),  strong  light  in  front  used  to  induce  at- 
tacks. Thinks  first  "what  am  I,"  then  gets  the  attack 
of  lapse  of  personality. 

Hypnoidal  state,  attack  set  on  with  hallucinations  of 
being  in  the  White  Mountains.  "I  think  I  was  brought 
up  to  be  introspective,  to  look  at  myself  from  the  out- 
side, selfish." 

Attacks  of  loss  of  personality  occur  in  his  sleep. 
The  personality  attacks  appear  in  dreams. 

When  he  says  his  prayers  he  is  predisposed  to  have 
attacks;  at  any  rate  he  Is  apt  to  get  into  trouble. 


Psychognosis  of  Psychopathic  Cases  207 

If  he  is  in  one  of  the  moods  and  says  his  prayers  then 
he  gets  an  attack.  Gets  his  fear  when  in  intermediate 
states,  especially  on  waking  up. 

December  24,  1908.  Patient  has  some  vague  at- 
tack-dreams in  sleep.  Wards  off  attacks  during  the 
day. 


D 
III 

The  attacks  or  lapses  started  at  a  very  early  age, 
due  to  intense  fear  on  the  part  of  the  patient;  the 
earliest  one  definitely  in  mind  is  that  which  occurred 
when  walking  at  night  down  a  street  with  long  rows  of 
lights.  Another  early  one  was  in  New  Hampsire 
(age  eight)  and  again  at  the  "Pompeii  performance" 
(age  ten).  All  of  these  were  promptly  forgotten  as 
soon  as  over  and  the  following  day  was  lived  with  no 
thought  of  them.  Even  when  (age  ten  and  a  half) 
the  attacks  came  regularly  from  night  to  night  when 
sent  out  alone  in  the  dark  on  errands.  Immediately 
upon  returning  home  the  experience  was  forgotten  and 
the  following  day  was  lived,  as  if  nothing  happened. 

When  at  the  age  of  thirteen  the  attacks  came 
on  once  more  (in  school  yard),  they  made  a  deep 
impression.  The  patient  deliberately  brooded  over 
them  at  that  time  and  would  spend  hours  alone,  buried 
in  the  mystery  of  them,  for  to  him  they  were  unusual, 
disconnected  with  anything  else  in  his  career  and  con- 
sequently seemed  essentially  mysterious.  The  ques- 
tion, "What  am  I.'"'  seemed  to  be  the  central  idea 
and  the  attack  itself  seemed  more  or  less  secondary. 
The  patient  used  to  insist,  when  questioned  by  physi- 
cians, that  he  asked  himself  the  philosophical  question, 


2o8     Causation  and  Treatment,  Psychopathic  Diseases 

"What  am  I?"  and  then  afterwards  experienced  the 
attack.  It  was  a  positive  relief  later  to  be  convinced 
that  the  attack  "really  came,"  that  is,  that  it  was  an 
emotional  state  and  not  the  result  of  a  mental  trouble. 
In  short,  the  whole  matter  was  bound  up  in  mystery 
in  the  mind  of  the  patient;  the  question,  "What  am  I?" 
indicating  that  he  felt  that  his  personality  was  involved 
in  some  mysterious  manner. 

This  brooding  mystery  has  been  the  fuel  which  sub- 
sequently has  fed  these  attacks.  Similar  ones,  natur- 
ally of  most  varied  character,  among  various  children, 
are  extremely  common,  but  are  usually  completely  lost 
and  forgotten  as  the  child  grows  older,  and  in  this  case 
they  would  have  died  out  naturally  for  want  of  atten- 
tion had  not  this  mysterious  feeling  and  attitude  con- 
cerning them  caused  them  to  be  kept  constantly  in 
mind. 

The  influence  upon  the  patient  of  the  sense  of  the 
mysterious  in  connection  with  this  trouble  is  of  the 
greatest  significance.  This  sense  of  the  mysterious  is 
shown  to  be  a  deep-rooted  part  of  his  make-up,  in  his 
attitude  toward  many  other  more  or  less  commonplace 
subjects,  notably  his  general  fear  of  the  dark.  It  is 
this  sense  of  the  mystery,  surrounding  these  attacks 
that  has  made  it  possible  for  them  to  assume  so  much 
importance  in  his  mind  and  consequently  to  develop. 
In  his  early  life  the  attacks  were  relegated  to  the  mys- 
terious and  the  hours  of  brooding  and  thought,  which 
he  spent  concerning  them,  were  executed  in  a  state  of 
great  emotion,  particularly  of  fear,  due  to  the  apparent 
mystery  of  the  whole  aflFair.  Each  subsequent  attack 
immediately  aroused  this  associated,  mystical  fear 
which  became  the  habitual  after-effect  of  every  attack. 
Gradually  the  fearful,  uncertain  state  of  mind  became 
more  stable  and  stronger  than  the  attack  proper,  be- 
cause it  persisted  over  long  intervals  of  time  and  was 


Psychognosis  of  Psychopathic  Cases  209 

a  cause  of  great  anguish  and  depression.  With  proper 
comprehensive  treatment  this  great  mass  of  associated 
fears  which  the  attack  arouses  should  no  longer  con- 
tinue and  consequently  its  main  source  of  annoyance 
should  be  removed. 

The  attack  comes  in  a  very  trifling  manner,  often  by 
some  little  twist  of  thought  under  just  the  proper  ex- 
ternal conditions.  Without  the  after  effect  of  fear, 
which  can  only  come  when  the  patient's  mind  regards 
the  whole  matter  as  being  dark  and  mysterious,  they 
would  gradually  dwindle  away  and  disappear. 

Lately,  the  patient,  while  being  tolerably  free  from 
attacks  proper,  experiences  more  the  direct  sensation 
of  fear  without  any  apparent  definite  cause.  This  is 
the  outcome  of  the  long  continued  habit  of  being  fear- 
ful which  has  been  developed  as  a  result  of  the  brood- 
ing and  consideration  of  the  mysterious  attacks. 

It  is  still  the  mystical  fear  concerning  these  attacks 
which  overpowers  him.  The  attack  is  a  momentary 
intense  fear,  perpetuated  from  child  experiences,  such 
as  was  aroused  in  him  when  out  alone  at  night  in  the 
dark  on  errands.  The  patient  retains  consciousness  and 
memory.  The  attack  itself  is  of  brief  duration,  and  if 
it  were  not  for  the  after-effects,  would  be  comparatively 
easy.  As  a  child,  the  experience  was  one  of  true, 
natural,  instinctive  fear,  causing  a  disturbance  in 
the  form  of  the  present  attacks,  which,  owing  to  later 
conditions,  was  never  outgrown  or  forgotten.  Instead, 
it  has  actually  been  cultivated  by  deliberate  brooding, 
and  by  thoughts  analagous  to  "What  am  I.?" 

The  attacks  are  short  in  duration.  It  is  only  the 
fear  of  them  and  the  after  anxiety  which  is  terrible. 
This  could  not  exist,  if  the  attacks  were  deprived  of  their 
mystery.  The  terrible  pang  that  comes  with  them  or 
when  thinking  of  them  sometimes  is  a  "panic"  of  fear. 


2IO     Causation  and   Treatment,  Psychopathic  Diseases 

Many  daily  experiences  in  the  patient's  life  show  his 
subconscious  suggestibility.  This  helps  him  to  under- 
stand that  the  sudden  attacks,  when  in  strange  sur- 
roundings, are  due  to  his  early  experiences.  This 
condition  of  worrying  has  persisted  for  so  long  a  time 
that  it  has  become  a  fixed  habit  and  has  gathered  with 
it  a  tremendous  amount  of  momentum.  Lately  the 
attacks  come  infrequently,  but  the  remembrance  or 
idea  of  them  which  comes  frequently,  arouses  the  pa- 
tient to  a  state  of  mental  anguish.  This  is  because 
during  all  the  past  years,  this  attack  has  been  associa- 
ted with  the  fearful  and  the  mysterious,  and  now  each 
time  it  flashes  across  his  mind,  it  brings  those  associa- 
tions with  it  in  the  form  of  a  vague  fear. 


D 

IV 

The  following  is  an  account  written  by  the  patient: 
"The  earliest  recollections*  I  have  of  nervous  troubles 
are  in  connection  with  being  sent  to  kindergarten 
school  at  the  age  of  four.  I  am  told  that  I  disliked 
to  go  to  school  and  persistently  fought  against  it, 
often  running  away  from  the  school.  I  now  confided 
much  in  my  parents  and  do  not  remember  that  I  told 
them  the  following,  but  it  probably  was  responsible 
for  my  dislike  of  school.  I  used  to  be  called  upon  by 
the  teacher  to  read  aloud  before  the  class,  consisting  of 
my  little  playmates.  This  I  did  with  terrible  dread, 
for  I  was  extremely  self-conscious  and  was  nearly 
overcome  with  the  thought  'Suppose  I  should  not  be 
able  to  speak  and  read  how  terrible  it  would  be  before 

•These  recollections  were  partly  revealed  by  the  hypnoidal,  twilight  method. 


Psychognosis  of  Psychopathic  Cases  21 1 

all  the  children.'  This  led  me  to  think  'How  do  I 
speak?'  which  thought  troubled  me  greatly,  and  at 
times  almost  interfered  with  my  speaking. 

"I  was  buried  in  a  snow-bank  about  this  time  (age 
four  years)  and  rescued  by  a  little  playmate  in  an  al- 
most smothered  condition.  I  have  absolutely  no  recol- 
lection of  this  event,  but  remember  having  heard  it 
spoken  of  a  few  years  after  it  happened  by  my  rescuer 
while  we  were  both  very  small  boys.  1  have  corrob- 
orated this  by  speaking  of  it  to  the  same  person,  now 
a  young  man  about  thirty  years  of  age.  All  through 
my  life  I  have  entertained  a  most  morbid  dread  of 
stifling  or  choking  or  smothering.  At  one  time  (age 
twelve)  I  used  to  ask  myself,  'How  do  I  swallow,'  until 
I  nearly  choked  at  meals.  At  another  time  (age 
twenty)  I  called  a  physician  in  the  night  fearing  I  was 
smothering,  when  I  had  in  reality  only  a  cold.  A  little 
bromide  gave  me  immediate  relief. 

"There  were  certain  streets  and  places  near  my  home 
which  always  seemed  gloomy  and  depressing,  although 
for  no  definite  reason.  (Age  four  to  eight.)  During 
this  period  (six  to  eight)  I  was  taken  to  the  White 
Mountains  with  my  mother,  father,  and  grandmother. 
My  father  was  quick-tempered,  high  strung,  nervous, 
and  intellectual.  I  was  always  striving  to  please 
him  and  hiding  from  him  everything  which  would  dis- 
quiet him.  He  was  much  excited  about  the  change  of 
trains  on  going  to  New  Hampshire  and  I  suffered  men- 
tally the  whole  responsibility  of  the  trip  of  caring  for 
my  mother  and  grandmother.  My  grandmother  was 
mortally  afraid  of  train  crossings  of  which  there  were 
plenty,  and  I  suffered  for  her  all  the  time  without  say- 
ing a  word.  Finally  on  one  of  our  trips  to  a  deep 
waterfall  gorge  in  the  mountains,  while  walking  along 
between  the  great  rock  cliffs,  I  was  overcome  with  a 
most  queer  sensation.     I  felt  disconnected  from  myself 


212     Causation  and   Treatment,  Psychopathic  Diseases 

— my  personality  was  unreal — I  had  an  attack  similar 
to  my  later  ones  which  frightened  and  disturbed  me. 
This  repeated  itself  at  least  once  again  during  the  trip; 
I  worried  and  thought  about  it  some,  but  still  I  never 
told  anybody  of  it. 

"Either  shortly  before  or  shortly  after  the  N.  H. 
trip  I  experienced  a  series  of  similar  attacks  while  out 
walking  one  night  with  my  uncle.  I  remember  the 
long  row  of  lamps  on  the  street,  and  how  strange  and 
frightened  I  felt,  but  I  said  nothing  about  it. 

"These  early  attacks  were  forgotten  the  next  day 
and  left  no  particular  ill  effects. 

"My  grandmother  cared  for  me  for  the  most  part 
and  used  to  hear  me  say  my  prayers  each  night  upon 
going  to  bed.  I  can  remember  nothing  unpleasant 
about  her  nor  her  method  of  training  me,  although  it 
might  well  be  that  the  following  characteristics  of  later 
life  are  due  to  her  religious  influence.  I  never  miss 
saying  prayers  upon  retiring  and  often  have  a  mild 
attack  at  the  time.  This  used  to  be  true  at  the  age  of 
thirteen  to  fourteen  more  than  nowadays.  Sometimes 
perverse  notions  such  as,  'Suppose  in  my  prayer  I 
should  curse,  etc.,'  often  disturb  me.  Neither  of  these 
has  been  a  great  source  of  trouble  to  me. 

I  have  always  had  a  great  fear  of  the  supernatural 
when  left  alone.  I  am  never  afraid  of  robbers  when 
alone  at  home  or  animals  when  alone  in  the  woods, 
but  am  mortally  afraid  of  the  sudden  appearance  of 
some  mysterious  unknown,  or  of  someone  departed,  as 
for  instance  the  ghost  of  one  of  my  parents.  This  was 
always  so  and  is  so  today,  perhaps  because  I  was  very 
much  alive  to  the  situation  at  the  time  of  my  mother's 
death  (age  eight)  and  of  my  father's  death  (age  eleven). 
This  also  never  disturbed  me  seriously,  although  it  is 
most  persistent  and  characteristic. 

"One  early  event  (age  seven  or  eight)  is  very  clear 


Psychognosis  of  Psychopathic  Cases  213 

in  my  memory.  I  was  at  the  theatre  with  my  mother 
and  father  to  see  the  terrible  tragedy  of  Soudan.  I 
remember  the  terrible  death  struggle  of  the  leading 
lady.  This  together  with  the  apparent  unreality  of 
the  whole  situation  within  the  theatre — the  crowd,  the 
lights,  etc.,  caused  me  to  have  a  definite  attack,  which 
however,  like  the  other  early  ones  was  promptly  for- 
gotten. 

"Considerably  later  (age  ten)  I  had  the  same  ex- 
perience when  witnessing  the  Fall  of  Pompeii  at  night 
in  an  open  air  theatre.  I  seemed  appalled  by  the 
unnatural  artificiality  of  the  situation — the  lights,  the 
crowd,  the  dreamlikeness  of  the  play,  all  made  me 
subtly  question  my  own  reality,  and  the  result  was  an 
attack. 

"In  later  years  I  have  at  times  been  suddenly  thrown 
into  an  attack  by  looking  into  a  moving  picture  machine, 
by  witnessing  moving  pictures  at  the  theatre  or  by  the 
great  display  at  a  place  like  the  St.  Louis  World's  Fair. 
A  strange,  crowded  city  street  often  does  the  same. 
Recently  I  had  the  same  tendency,  but  I  can  usually 
avoid  the  strenuous  attack,  because  I  realize  what  it 
is,  and  am  not  thrown  into  a  panic  of  fear  at  the  first 
slight  effect. 

"The  year  before  my  father's  death  (age  eleven)  I 
had  a  number  of  attacks.  He  used  to  send  me  to  the 
store  alone  at  night,  and  invariably  at  a  certain  hill,  as 
I  looked  down  upon  the  lighted  square  below,  I  had  an 
attack.  I  was  terribly  frightened  to  go  out  alone. 
These  were  probably  the  first  systematic  attacks. 
Again,  when  far  from  home  on  a  bicycle  ride,  and  often 
on  the  way  back  to  the  city  from  the  beach  with  him, 
I  had  attacks.  I  used  to  be  sent  upstairs  alone  at 
night  to  practice  on  the  piano  for  an  hour.  I  was 
afraid  to  be  alone,  and  was  tired.  The  light  seemed  too 
bright,  at  times,  almost  as  if  it  shone  into  my  head 


214     Causation  and  Treatment^  Psychopathic  Diseases 

through  holes.     I  would  suddenly  stand  up  from  the 
piano  stool  in  the  midst  of  an  attack. 

"None  of  these  left  after-effects  the  next  day,  nor 
did  I  tell  anyone  about  them. 

"One  day  I  returned  home  from  playing  all  morning, 
and  was  waiting  with  my  father  for  dinner.  I  had  no 
attack,  but  a  terrible  anxiety  or  fear  hung  on  me.  For 
the  first  time  I  confided  in  him  saying,  'I  am  afraid.' 
This  was  promptly  forgotten  like  the  rest.  I  was  a 
vigorous,  active  boy,  unusually  bright  at  school,  and 
advanced  for  my  age.  This  was  not  interfered  with 
by  my  attacks,  although  I  recall  many  occasions  when 
I  seemed  strange  and  greatly  depressed.  When  I  was 
at  the  age  of  eleven,  my  father  died  and  I  was  left  with 
a  guardian  whose  family  felt  little  sympathy  for  me.  I 
had  occasional  attacks  of  small  consequence  until  I  was 
thirteen  years  of  age. 

"At  this  age,  one  day  in  the  bright  sunshine,  while 
entering  the  school  yard,  I  had  an  extremely  severe 
attack.  I  yielded  to  this  and  returned  home,  having 
several  other  attacks  on  the  way.  For  days  I  could 
not  relieve  my  mind  of  the  matter.  In  some  way  I  got 
hold  of  the  question,  'What  am  I'  in  connection  with 
the  sensation  of  the  attack.  My  guardian  laughed  at 
my  plight,  and  I  would  lie  alone  in  my  room  for  hours, 
brooding  and  thinking  about  the  attack  and  'what  am 
I.'  Physicians  were  visited  who  neither  understood 
my  condition  nor  interested  themselves  particularly 
in  me.  I  used  to  say,  'I  think  "what  am  I,"  and  then  I 
don't  know  what  I  am  and  have  an  attack.'  I  used  to 
answer  after  much  reasoning  that  I  am  just  what  is 
asking  the  question,  'What  am  I'  and  desiring  an  answer 
to  it  and  feeling  so  badly.  This  answer  relieved  me 
temporarily.  In  this  way  I  went  on  for  months  having 
almost  daily  attacks  at  intervals.  I  finally  persuaded 
myself  that  this  was  a  real  attack.     The  attacks  came, 


Psychognosis  of  Psychopathic  Cases  21 5 

too  numerous  to  tell.  Dr.  T.  gave  me  bottle  after  bot- 
tle of  bromide.  This  severe  condition  lasted  about  six 
months  (age  thirteen).  Often  at  the  dinner  table  which 
was  brightly  lighted  from  overhead  and  at  which  I  was 
an  insignificant  unit  among  a  very  large  family,  I  would 
disturb  the  meal  by  rising  from  my  place  in  the  midst 
of  an  attack.  I  received  no  sympathy,  and  would  re- 
turn to  my  room  to  brood. 

"During  the  summer  months  I  went  to  a  seaside 
resort  with  the  family  and  improved  somewhat.  Upon 
returning  I  entered  high  school  for  the  first  time.  At 
the  first  exercise  I  was  obliged  to  leave  the  room,  be- 
cause of  an  attack.  That  was  the  last  attack  for  three 
years.  For  some  reason  I  was  absolutely  free  from 
them  during  the  next  two  years  at  high  school  and  the 
following  first  year  at  business.  I  was  fascinated  with 
my  work,  making  scholarship  records,  winning  prizes, 
etc.,  and  I  practically  forgot  that  I  ever  had  an  attack. 

"After  a  year  in  business  (age  seventeen)  the  old 
trouble  came  on  again,  at  first  in  a  peculiar  form.  I 
had  grown  very  rapidly  and  I  was  very  tall  and  lean. 
I  got  the  idea  that  my  shoulders  were  too  narrow  and 
the  idea  tormented  me.  I  would  look  on  every  possible 
occasion  to  see  my  image  in  mirrors,  in  store  windows, 
and  I  asked  everybody's  opinion.  I  would  convince 
myself  that  I  was  all  right,  which  would  satisfy  me  for 
an  hour  or  so,  and  then  I  would  circle  through  the  same 
old  chain  of  thoughts  and  worries  about  my  shoulders 
again  and  again,  I  soon  began  to  have  attacks  of  the 
old  type  which  displaced  the  shoulder  affair.  This 
continued  off  and  on  for  a  year.  Then  I  left  the  busi- 
ness world  to  enter  the  Institute  of  Technology.  (Age, 
eighteen.) 

"Again  I  had  a  long  period  of  well-being  which  lasted 
for  four  years.  I  was  absorbed  in  and  enthusiastic 
about  my  work  and  ambitious   to  win  scholarships. 


2i6     Causation  and   Treatment,  Psychopathic  Diseases 

I  had  during  this  time  a  few  isolated  attacks,  as  for 
instance,  upon  visiting  Coney  Island  for  the  first  time, 
but  in  general  I  enjoyed  vigorous  health  until  near  the 
end  of  the  fourth  year.  At  that  time  I  had  a  severe 
pressure  on  the  top  of  my  head,  probably  from  over- 
work during  the  preceding  years.  Towards  the  very 
end  I  had  one  or  two  attacks,  but  they  were  light  and 
left  no  after  effects. 

"Immediately  upon  graduation  I  left  Boston  for 
San  Francisco  to  accept  a  position  as  a  teacher.  On 
the  way  west  I  stopped  over  at  Philadelphia,  Washing- 
ton, St.  Louis  Exposition,  etc.,  and  at  each  place  had 
terrible  attacks.  As  soon  as  I  was  located  in  San 
Francisco  I  was  free  from  them  again  for  nearly  a  year. 

"Toward  the  close  of  the  San  Francisco  year,  which 
had  been  an  exceptionally  busy  and  hard  one,  I  began 
to  get  attacks  regularly  in  the  evening,  and  in  particu- 
lar situations.  I  had  been  well  for  so  long  that  I  paid 
but  little  attention  to  them.  I  was  then  sent  to  Ger- 
many for  two  years  by  the  M.  I.  Technology  for  ad- 
vanced study.  I  sailed  with  my  wife  and  Dr.  C,  for 
what  should  have  been  the  best  years  of  my  life,  but 
they  were  spoiled  by  continued  attacks  and  depres- 
sions. 

"I  couldn't  go  out  to  walk  at  night  in  Berlin  without 
an  attack.  The  same  was  true  at  Zurich.  In  the 
mountains  during  vacations  it  was  the  same.  A  week 
of  peace  and  then  two  weeks  of  depression,  worry,  and 
attacks.  I  brooded  over  my  condition  and  grew 
steadily  worse.  I  consulted  Dr.  Von  Monakow  and 
just  before  returning  home,  Dr.  P.  Janet.  These  were 
my  twenty-fourth  and  twenty-fifth  years. 

"I  was  given  electrical  treatments,  baths,  diets,  etc., 
but  to  no  avail.  The  idea,  'what  am  I'  no  longer  con- 
cerned me,  but  the  attack  was  so  strange,  so  unusual, 
80  uncorrelated,  so  mysterious,  and  so  terrifying,  and 


Psychogfwsis  of  Psychopathic  Cases  217 

fearful!  I  could  get  no  satisfactory  idea  about  what 
it  was  or  what  caused  it.  Consequently,  the  after 
effects  of  an  attack  were  prolonged  for  days  by  brood- 
ing and  fear  concerning  them.  I  was  simply  waiting 
for  them  to  stop  in  the  same  mysterious  manner  in 
which  they  apparently  had  come. 

"One  day  in  France  I  fairly  shrieked  with  the  pangs 
of  fear  with  which  I  was  seized  without  apparent  cause. 

"I  returned  to  Boston  (age  twenty-five).  For  a  few 
months  after  my  return  I  was  somewhat  better  under 
the  stress  of  new  conditions.  But  I  soon  fell  back  into 
the  same  rut.  The  steady  depression  and  worry  be- 
tween  attacks  were  wearing  upon  me. 

"After  visiting  several  physicians,  with  very  little  if 
any  benefit,  I  visited  Dr.  Sidis.  He  threw  an  entirely 
new  light  upon  the  whole  affair.  It  has  taken  three 
years  (age  twenty-five  to  twenty-eight)  of  persistent 
work  with  me  to  break  my  old  habits  of  mind  concern- 
ing myself  and  the  attacks.  By  completely  changing 
my  attitude  toward  myself,  my  condition  and  my  at- 
tacks, by  furnishing  me  with  a  new  point  of  view, 
Dr.  Sidis  has  caused  the  trouble  to  be  robbed  of  its 
terrors,  and  the  attacks  to  dwindle  away. 

"From  my  point  of  view  the  main  steps  along  the 
road  of  improvement  with  Dr.  Sidis  were  as  follows : 

"It  was  a  revelation  to  me  to  be  told  when  I  first 
described  an  attack  by  saying  that  my  'personality  was 
gone'  that  I  'lost  myself,'  that  that  was  meaningless 
except  for  a  state  of  unconsciousness^  that  it  was  only 
a  panic  of  fear  which  overcame  me  and  which  para- 
lyzed my  sense  of  reality  or  famiHarity  for  a  very  brief 
interval.  'Granted  a  second  modification  of  person- 
ality— what  of  it.''  What  a  small  fraction  of  one's 
day  after  all,  if  only  the  after-worry  be  suppressed.' 
That  was  an  extremely  new  idea  and  a  powerful  tool 
for  me.     It  robbed  the  attack  of  most  of  its  mystery,  for 


21 8     Causation  and   Treatment^  Psychopathic  Diseases 

it  was  now  merely  a  temporarily  modified  'me'  in  a 
state  of  peculiar  fear,  and  not  a  mysteriously  lost  'me'. 
'/  was  there  all  the  time.^  'Only  a  very  small  part  of 
the  great  complex  of  personality  is  affected  during  an 
attack,'  was  a  powerful  sentence  for  me. 

"I  soon  wanted  to  know  the  cause  of  these  sudden 
onrushes  of  fear  which  came  without  apparent  cause. 
Might  not  Dr.  Sidis  be  mistaken,?  Might  they  not  be 
due  to  something  organic  about  which  it  was  best  not 
to  inform  me?  I  think  nothing  but  months  of  con- 
sistently repeated  answers  to  my  torrent  of  questions 
could  have  persuaded  me  about  these  points.  Had  I 
been  able  just  once  to  get  the  upper  hand  of  the  argu- 
ment, all  would  have  been  lost. 

The  critical  answers  were — (i)  It  can't  be  organic  or 
how  could  the  event  of  the  attacks  depend  as  they  do 
upon  exterior  surroundings.  (2)  The  fear  is  due  to  a 
series  of  events  in  early  childhood,  which  events  were 
traced  down  in  the  hypnoidal  state  and  by  long  periods 
of  reflection  on  my  part.  It  seems  reasonable  and  pro- 
bable, since  the  personality  of  a  child  is  not  very  rigid 
and  depends  largely  upon  familiar  surroundings  for  its 
normality,  that  the  peculiar  manifestation  (the  attack) 
might  at  first  be  entirely  due  to  fear.  I  still  remem- 
bered continued  events  such  as  the  night  errands  with 
accompanying  attacks  immediately  forgotten  upon  re- 
turn home  which  assured  me  of  this  point.  It  is  easier 
to  understand  repetitions,  if  the  first  ones  are  explained. 

"The  first  attacks,  then,  are  the  result  of  childish 
fear.  The  sensation  was  so  unique  that  it  seemed 
mysterious.  It  was  like  a  taste  of  another  world.  So 
long  as  it  seemed  mysterious  it  was  brooded  over, 
deemed  all-important  and  exaggerated,  until  it  occupied 
the  whole  mental  horizon.  As  soon  as  it  was  robbed  of 
its  mystery  and  regarded  as  a  brief  acute  fear  state 
which  manifested  itself  acutely,  because  of  having  be- 


Psychognosis  of  Psychopathic  Cases  219 

gun  in  an  undeveloped  personality  of  a  child,  it  was 
robbed  of  its  sting  of  terror. 

"Another  important  point  which  I  have  lately  be- 
gun to  appreciate  is  as  follows:  Since  these  attacks 
were  for  so  many  years  associated  with  ideas  of  mystery 
and  enormous  importance,  the  slightest  trace  of  one 
arouses  a  flood  of  emotion.  These  emotions  are  anxie- 
ties and  fears,  and  are  due  to  their  frequency  of  repeti- 
tion, they  now  come  with  tremendous  momentum. 
Sometimes  the  anxieties  and  fears  come  without  the  at- 
tacks. The  temptation  is  to  start  thinking  about  my 
condition,  revolving  in  my  mind  much  of  my  history  in 
connection  with  the  attacks.  It  seems  as  if  there  must 
be  something  more  behind  which  could  be  thought  out, 
and  which  would  satisfy  me,  if  I  could  only  grasp  it.  If  I 
yield  to  this  temptation,  I  soon  have  a  cloud  hanging 
over  me  which  persists  for  days  during  which  I  am 
subject  to  attacks.  The  mere  remembrance  of  my 
previous  condition  which  often  strikes  me  with  great 
force  after  a  period  of  well-being,  as  when  one  suddenly 
remembers  something  of  importance  which  has  been 
forgotten,  is  enough  to  start  me  off,  if  I  yield  to  the 
temptation. 

"The  point  is  not  to  yield  to  that  critical  moment. 
Put  it  off  for  a  few  minutes.  Then  the  flood  of  emo- 
tions has  passed  away,  the  matter  is  considered  reason- 
ably and  calmly,  and  its  importance  is  gone.  It  doesn't 
seem  worth  considering  then.  Dr.  Sidis  has  made  this 
possible. 

"Sometimes  the  thought  that,  although  I  have 
practically  all  my  life  been  subject  to  these  attacks, 
yet  they  have  not  interfered  with  my  career,  which 
has  been  an  unusually  full  and  busy  one,  satisfies  me 
that  they  cannot  be  so  all-important  and  worthy  of 
much  attention.  This  reflection  has  at  times  a  sooth- 
ing effect,  and  often  is  just  sufficient  to  enable   me 


220     Causation  and  Treatment^  Psychopathic  Diseases 

to  keep  from  meddling  with  the  affair  until  I  work 
myself  into  a  state  of  depression. 

"It  is  important  to  understand  that  the  severity  of 
an  attack,  the  determining  factors  as  to  whether  it 
'takes  hold'  to  cause  its  terrible  wake  of  after  effects 
or  not,  is  largely  what  I  put  into  it  at  the  time  of  its 
recurrence.  Like  most  phenomena,  these  attacks 
always  have  an  immediate  and  a  remote  cause.  In  the 
beginning  the  immediate  cause  was  fear  induced  by 
unfamiliar  surroundings,  darkness,  etc.,  inducing  a 
fear  which  in  an  undeveloped  personality  of  a  child 
gave  rise  to  a  sensation  of  disconnected  or  lost  self. 
The  fundamental  cause  which  made  this  possible  was 
my  fearful,  anxious,  mystical  temperament,  due  to  my 
manner  of  bringing  up.  This  is  illustrated  by  the  case 
of  a  very  young  child  first  hearing  thunder.  Whether 
or  not  it  will  leave  vague  fears  of  that  apparently 
terrifying  and  mysterious  sound  for  ever  after,  depends 
largely  upon  the  attitude  of  those  older  persons  present 
when  it  is  first  experienced. 

"This  temperament  is  Hke  the  fuel  or  gun  powder, 
while  the  immediate  cause  is  like  the  spark,  in  the  case 
of  an  explosion. 

"Later  on  (age  thirteen-seventeen)  the  same  im- 
mediate cause,  i.  e.  darkness,  etc.,  would  not  induce  an 
attack.  Peculiar  special  surroundings  or  subtle  sug- 
gestions, certain  trains  of  thought  or  effects  of  light 
(reminded  [.?]  me  of  the  early  attacks)  and  induced 
new  ones.  These  induced  attacks  might  be  consciously 
self-induced,  consciously  externally  induced^  or  sub- 
consciously induced.  Most  of  them  were  the  latter, 
and  came  suddenly.  During  this  period,  however,  the 
attack  visited  a  different  personality.  It  seemed 
strange  and  mysterious,  causing  the  thought,  'What 
am  L'  This  the  simple  mind  of  a  child  could  not  add 
to  the  brief  attack  proper,  and  it  soon  was  forgotten. 


Psychognosis  of  Psychopathic  Cases  221 

Now,  however,  (age  thirteen-seventeen)  these  new 
thoughts  and  attendant  fearful  emotions  were  habitual- 
ly indulged  in  after  an  attack,  and  they  made  a  differ- 
ent attack  of  it.  At  one  interval  it  seemed  that  the 
thought,'What  am  I,'  preceded  and  caused  each  attack 
(age  thirteen). 

"Recently  (27-8)  the  immediate  cause  of  an  attack, 
when  it  is  not  purely  subconscious,  is  subtle  eifects  of 
light,  the  confusion  of  a  crowded  street,  etc.  This 
causes  a  peculiar  sensation  to  be  experienced  which, 
when  not  understood,  is  very  frightening,  that  of 
changed  connection  between  mind  and  body,  as  if  the 
body  were  operating  without  the  control  of  the  mind, 
in  short,  a  change  in  personality.  The  effect  is  now 
upon  a  very  different  personality  from  that  of  old.  It 
is  the  same  picture  on  a  different  background.  The 
attack  visits  a  new,  older,  more  experienced  and  stabler 
personality.  This  present  personality  realizes  the  his- 
tory of  its  development  and  that  of  the  attack,  and  of 
its  habits  of  fear  and  fright,  due  to  its  attitude  of 
mystery  toward  the  attacks.  Consequently,  it  now 
does  not  regard  the  attacks  as  fearful  or  mystical.  The 
result  is  that  the  sting  and  the  after  effect  are  gone  and 
the  attack  seems  unimportant.  It  is  no  longer  a  funda- 
mental question  of  *What  am  I',  bound  in  feverish, 
mystical  anxiety,  but  an  explained  panic  of  fear,  over- 
whelming only  for  a  fraction  of  a  second,  due  to 
childish  experiences  and  habit. 

"The  whole  matter  may  be  summed  up  in  three  words 
Fear,  mystery,  and  importance.  Natural  instinctive 
fear  starting  in  childhood  was  the  early  origin  of  the 
attack  about  which,  as  time  passed,  a  network  of 
mystery  was  woven.  While  mystical  and  not  under- 
stood, the  effect  seemed  all  important  and  was  given  a 
tremendous  amount  of  attention  of  the  vague,  anxious, 


222     Causation  and  Treatment^  Psychopathic  Diseases 

fearing,  emotional  kind,  which  further  cultivated  the 
attacks. 

"The  attack  proper  has  always  been  quite  uniform 
in  its  nature,  but  it  has  been  surrounded  through 
twenty  years  off  and  on  of  practice  with  great  quantities 
of  moss.  This  moss  varied  in  kind  and  quantity,  and 
is  the  real  source  of  trouble.  So  oft  repeated  has  the 
attack  and  its  after  effects  of  worry,  etc.,  been,  that 
this  worrying  tendency  has  acquired  tremendous 
momentum. 

"The  important  cause  of  suffering  has  not  been  the 
brief  attack  itself,  but  it  has  been  the  after  effect  of 
fear  and  worry.  It  has  been  the  attitude  of  my  per- 
sonality toward  this  brief  acute  sensation  which  has 
built  a  fortification  of  mystery  about  it,  so  that  it  has 
become  more  oft  repeated  and  apparently  more  intense. 
More  and  more  possibilities  of  suggesting  or  inducing 
an  attack  were  on  hand  the  more  I  brooded  about  it 
and  the  more  strange  things  I  connected  it  with  in 
my  thoughts. 

"While  young  and  with  a  simple  mind,  I  saw  nothing 
special  in  the  attacks  and  they  were  readily  forgotten. 
As  my  mind  developed  I  regarded  them  in  ever  so  many 
new  ways,  and  particularly  from  the  view-point  of  the 
fearful  and  the  mystical.  This  aroused  new  emotions, 
and  the  study  and  worry  were  repeated  and  repeated, 
always  resulting  in  fresh  depressions  and  attacks,  be- 
cause no  satisfying  conclusions  were  reached.  The 
more  this  continued,  the  more  important  the  attack 
seemed,  and  the  more  channels  to  suggest  the  sensa- 
tion were  opened  to  me. 

"Only  recently,  with  a  clear  conviction  that  the  first 
cause  was  fear,  that  the  chief  fuel  had  been  mystery  and 
my  own  attitude,  has  their  importance  waned,  and  with 
this  the  whole  matter  is  gradually  losing  itself  in  the 
stream  of  now  apparently  more  important  matters." 


Psycho  gnosis  of  Psychopathic  Cases  223 

The  history  of  this  case  written  by  the  patient  from 
his  own  present  standpoint  needs  no  further  interpreta- 
tion. For,  as  the  patient  clearly  realizes  it, — fear  and 
mystery  are  at  the  basis  of  his  trouble,  as,  in  fact,  they 
are  at  the  basis  of  all  psychopathic  maladies. 

E 
I 

Patient  is  a  young  man  of  twenty-seven  years.  His 
parents,  though  slightly  neurotic,  have  reached  a  good 
old  age.  Patient  is  physically  well.  Since  early  child- 
hood, as  far  back  as  the  age  of  eight,  he  has  suffered 
from  intense  melancholic  depression,  often  reaching  a 
state  of  agony.  He  is  obsessed  by  the  fear  of  having 
committed  the  unpardonable  sin.  He  thinks  he  is 
damned  to  suffer  tortures  in  hell  for  all  eternity.  He 
keeps  on  testing  any  chance  combinations,  and  if  his 
guesses  turn  out  correct,  he  is  wrought  up  to  a  pitch 
of  excitement  and  panic.  For  it  is  to  him  a  communi- 
cation coming  from  an  unseen  world  by  unknown 
mysterious  powers.  Diagnosed  as  "paranoidal  demen- 
tia prsecox,"  the  patient  was  committed  to  an  insane 
asylum,  from  which  he  was  subsequently  released. 

"The  omen  testing,"  he  writes  in  his  account  to  me, 
"had  a  monstrous  growth.  The  tests  have  been  con- 
cerned with  the  letters  in  my  reading,  with  people  walk- 
ing on  the  street,  with  carriages  and  automobiles,  fire 
alarms,  sounds  of  all  kinds,  the  sound  of  the  voice  and 
of  birds,  hymns  in  church,  the  weather,  the  arrangement 
of  letters  in  conversation,  etc.  The  general  principle 
has  been  the  same  throughout,  which  is  briefly  this: 
If  the  normal  course  of  events  is  interfered  with  in  a 
special  way  that  I  arbitrarily  arrange  in  my  mind  be- 
fore the  happening,  I  infer,  or  rather  fear,  that  it  is  a 
signal   from   some   extraneous   intelligence.     As   to   a 


224     Causation  and   Treatment,  Psychopathic  Disease^ 

signal  of  what,  that  also  is  arbitrarily  arranged  before- 
hand. For  instance,  I  considered  it  was  not  the  normal 
course  of  events  to  be  able  to  predict  on  what  day  of 
the  week  several  people  would  arrive  at  the  hotel,  and 
still  I  predicted  it.  I  feared  either  that  I  had  a  super- 
natural power  of  prediction  or  that  the  people  them- 
selves were  in  some  supernatural  way  forced  to  fall  in 
with  the  day  I  predicted. " 

The  attack  proper  comes  in  pulses  of  brief  duration 
followed  by  long  periods  of  brooding,  depression,  and 
worry.  The  primitive  fear  of  danger  and  death,  and 
the  sense  of  the  mysterious,  cultivated  by  his  religious 
training,  reached  an  extraordinary  degree  of  develop- 
ment. 

Among  the  earliest  memories  that  have  come  up  in 
the  hypnoidal  state  was  the  memory  of  a  Sunday- 
school  teacher  who  cultivated  in  the  patient,  then  but 
five  years  of  age,  those  virulent  religious  germs  which, 
grown  on  the  soil  of  the  primitive  instinctive  fear  and 
the  highly  developed  sense  of  the  unknown  and  the 
mysterious,  have  brought  forth  those  poisonous  fruits 
which  now  form  the  curse  of  his  life. 

Another  paragraph  from  the  patient's  account:  "It 
is  difficult  to  place  the  beginning  of  my  abnormal  fear. 
It  certainly  originated  from  doctrines  of  hell  which  I 
heard  in  early  childhood,  particularly  from  a  rather 
ignorant  elderly  woman  who  taught  Sunday-school. 
My  early  religious  thought  was  chiefly  concerned  with 
the  direful  eternity  of  torture  that  might  be  awaiting 
me,  if  I  was  not  good  enough  to  be  saved, 

"<2.  To  sum  up  briefly  an  account  of  the  fear  which 
is  the  bane  of  my  life.  The  most  general  way  to  ex- 
press that  fear  is  to  say,  it  is  a  fear  of  some  dreadful 
calamity  happening  to  my  conscious  self  after  death. 
That  is  to  say,  a  fear  that  my  present  suffering  will  con- 
tinue  or  something  worse,   perhaps   infinitely  worse, 


Psychognosis  of  Psychopathic  Cases  225 

will  come.  This  feeling  is  always  very  closely  allied 
to  the  early  theological  doctrine  of  hell. 

'^b.  The  intellectual  processes  leading  up  to  this  fear 
are  two:  first,  that  I  may  deserve  this  punishment  at 
the  hands  of  justice,  on  account  of  failure  to  attain  the 
moral  standard  which  is  required  of  everybody  who 
knows  enough;  second,  that  I  am  receiving  communica- 
tions from  discarnate  intelligence,  confirming  this  fear. 

"c.  Taking  first  the  idea  of  moral  failure,  it  seems 
to  me  that  God,  justice,  or  whatever  you  choose  to  call 
it,  requires  from  every  individual  who  is  intelligent 
enough,  a  certain  standard  of  goodness  or  morality, 
failing  which  the  individual  suffers  corresponding  to 
the  magnitude  of  failure.  I  believe  that  I  have  failed 
to  reach  this  standard  to  a  very  great  degree  and  am  so 
continuing,  for  I  am  constantly  neglecting  the  duties 
around  me  which  other  people  have  the  moral  courage 
to  do. 

'V.  Taking  up  the  second  point,  that  of  spiritual 
communication,  I  must  admit  that  the  general  principle 
seems  fundamentally  irrational,  and  yet  many  highly 
intelligent  men  of  modern  times  admit  the  possibility 
of  communication  with  the  spirits  of  the  dead.  My 
difficulty  in  this  respect  is  that  the  results  I  get  from 
testing,  while  not  intrinsically  impossible  or  miraculous, 
are  such  that  it  is  difficult  for  me  to  explain  them  by 
chance  or  anything  else  other  than  outside  intelligent 
design." 

E      __- 

II 

I  give  here  some  of  my  clinical  notes  of  the  case : 
When  young,  patient  used  to  think  of  eternity;  got 
it   from   the   "old   teacher."     Wondered   that   things 
should  have  no  beginning  and  no  end.     Connected  it 


226     Causation  and  Treatment,  Psychopathic  Diseases 

with  hell,  in  that  maze  early  fear  began.  The  patient 
thinks  that  the  idea  of  "endless"  was  at  that  time  his 
great  trouble. 

Had  dream:  catching  dogfish,  fish  horrible,  snake- 
like; men  ridiculing  him.  Snake  and  dog — horrible  ex- 
perience which  patient  undergoes.  (Patient  has  fear  of 
dogs,  his  mother  too  has  it.)  Snake-serpent-devil,  dam- 
nation-feeling, devil  is  damned,  he  is  the  devil. 

Testing  in  dreams  is  rare.  The  testing  of  respiration 
in  conversation  does  not  enter  into  dreams.  Guessing 
in  odd  or  even  numbers  may  come  up.  Memorizes  let- 
ters, odd  and  even  letters,  and  tests  them  whether  odd 
or  even,  beginning  of  sentence  or  middle  of  sentence  or 
fifth  letter.  Sense  of  depression  in  dreams  expresses 
itself  in  the  form  of  damnation. 

In  the  church,  if  the  40th  letter  is  t,  it  is  confirma- 
tory, so  it  was,  the  20th  s,  the  12th  0 — confirmatory. 
From  church  took  hymn-book — the  70th  will  be  d — 
found  word  "diadem." 

Fear  of  death,  of  the  unknown,  of  the  consequences 
of  damnation. 

In  conversation  with  me,  while  I  talked  to  him  about 
his  state  of  fear  of  damnation  and  testing,  he  kept  on 
testing  the  letters  of  my  conversation,  "whether  the 
fifth  letter  of  my  words  will  be  a  certain  letter?" 

In  the  hypnoidal  state  very  little  testing  is  done. 

Told  me  of  a  superstitious  fear  that  when  parents 
went  away  they  will  not  return,  not  that  they  will  meet 
with  an  accident,  but  that  they  will  simply  disappear. 
It  was  not  a  natural  fear,  but  a  superstition.  Then  if 
such  a  thing  should  happen  It  would  be  a  sign  of  "di- 
vine wrath. "  The  fixed  fear  was  tenacious.  If  parents 
went  away  with  other  people  the  feeling  was  not  so 
intense,  because  they  (the  parents)  could  be  traced 
naturally.  It'Is  only  the  mysterious  that  appealed.  In 
school  looked  out  of  the  window  to  see  carriages,  may- 


Psychognosis  of  Psychopathic  Cases  227 

be  parents  disappear.  When  left  alone,  "solitude,"  or 
with  stranger,  something  terrible  may  happen.  (Com- 
pare other  cases.)       Kept  up  this  fear  until  twenty. 

When  very  young,  parents  went  away,  left  him  with 
servant,  cried  very  much.  Went  to  sleep.  When  they 
returned,  he  woke,  but  he  thought  he  was  dreaming, 
not  real.  Was  about  six  years  old.  The  fear  instinct 
developed.  Damnation  was  torturing  in  "fire,"  all 
alone  in  solitude  and  away  from  parents  (natural  child- 
ish fear).  Hell  is  to  he  all  alone  in  a  dark  place.  Had 
fear  of  walking  in  a  dark  room  without  having  helping 
hand  or  some  object — was  afraid  he  may  go  on  so  to 
eternity.  Even  the  year  before,  when  in  "Wonderland," 
had  to  go  through  dark  tombs,  fear  had  been  resur- 
rected. 

The  fear  became  occasionally  exacerbated  by  the 
different  forms  of  testing.  Then  employed  dates  and 
letters  as  a  test.     The  date  is  even  or  odd. 

Dreamt  I  was  in  his  dream,  spring  was  coming, 
birds  would  come  singing,  patient  testing  their  song  on 
expiration  and  inspiration.  I  told  him  something, 
could  not  remember  at  first  what,  "was  worried  about 
testing,  I  explained  him  the  insight  of  it. "  It  was  some 
actual  physical  disturbance,  superstition,  strange. 
There  was  a  feeling  of  oppression — the  same  as  waking 
depression . 

Between  eight  and  fifteen  liked  excitement,  but  then 
the  excitement  made  him  think  he  is  diabolical. 

Dreamt  he  was  in  a  boat  with  religious  people  dis- 
cussing about  God,  resurrection,  and  damnation;  saw 
figures  computing  the  time  between  now  and  resurrec- 
tion; the  people  were  Universalists.  The  Sunday  school 
teacher  used  to  dwell  on  the  length  of  time  to  resurrec- 
tion, a  day  being  a  thousand  years. 

I  said  "I  shall  subject  all  that  to  test  to  see  whether 
it  is  true  or  false."     Came  across  a  phrase  relief  to  him: 


228     Causation  and  Treatment,  Psychopathic  Diseases 

the  present  fears  are  realized.  Always  sees  the  same 
phrase,  sees  it  always  the  same  day  in  the  week.  This 
must  surely  have  "a  meaning",  keeps  a  diary.  Found 
that  the  phrases  occurred  on  Tuesday.  Still  the  proba- 
bility is  one  in  seven.  Then  continued  testing  in  other 
ways.  He  kept  playing  the  chance-game.  Could  not 
attribute  results  to  mere  chance.  Now  he  keeps  on 
testing  nearly  all  the  time  in  relation  to  the  condem- 
nation. Came  down  to  odd  and  even,  got  so  that  he 
must  follow  it  up. 

Before  he  conceived  the  idea  of  blaspheming  against 
the  Holy  Ghost  he  used  to  go  over  in  his  mind  that  he 
was  not  good  during  the  day,  making  decisions  of  being 
better  next  day.  The  people  around  him  used  Biblical 
testing.  There  was  an  atmosphere  of  religious  and 
other  superstitions  in  the  place.  Mother  superstitious. 
Mother  used  the  Bible,  opening  it  to  test  the  outcome 
of  events,  especially  when  in  trouble.  Even  last  sum- 
mer mother  showed  him  verse  which  just  came  by  open- 
ing the  Bible;  the  verse  was  very  favorable.  Bible 
stories  hammered  into  his  head.  When  rain,  was  afraid 
of  flood. 

When  about  the  age  of  nine,  a  fear,  a  horror  used  to 
come  over  him,  it  was  intense,  awful.  This  came  on 
suddenly,  more  real  than  usual,  so  intense  that  it  could 
not  last,  reaction;  this  occurred  before  testing  was 
systematized  at  Harvard  (1902,  age  twenty).  Was  very 
depressed;  then  the  phrase  "worst  fear  true,"  then  in 
reading  the  worst  came  which  is  unusual.  Seemed 
significant — origin  of  testing,  felt  at  the  same  time  that 
the  testing  was  "absurd  and  even  dangerous."  De- 
pression partly  ascribed  by  patient  to  homesickness, 
and  keeping  away  from  people  and  friends, — loneliness 
in  a  crowd.  Did  not  take  an  interest  in  his  work. 
The  fear  became  overwhelming,  when  passing  a  sand 
heap  each  unit  meant  a  year  of  damnation;  when  near  a 


Psychognosis  of  Psychopathic  Cases  229 

hot  radiator  thought  of  the  "fire  of  hell."  Any  depres- 
sion emphasized  the  fear  of  "damnation."  Had  to  use 
resisting  power  to  the  dominant  idea.  Anything  of  a 
depressing  character  hardly  diverted  his  attention  from 
the  "fear."  Now  the  "testing"  shows  that  he  is  in  a 
constant  state  of  doubt  and  indecision. 

The  indecision  manifested  itself  by  constant  delay. 

"Good  resolutions  the  curse  of  my  life."  Makes  no 
resolution. 

About  four  years  ago  when  tired  and  depressed  a 
fearful  feeling  of  unreality  came  over  him. 

Often  dreams  of  seeing  dead  people,  because  of  ex- 
perience of  being  buried  alive,  also  connected  with  his 
ideas  of  sin  and  damnation. 

Testing  as  to  whether  he  could  suffer  vicarious  suffer- 
ing when  about  the  age  of  sixteen.  "Sacrifice  myself 
for  others. " 

Dreamt  about  a  funeral  (has  frequent  dreams  of 
funerals).  Thinks  it  was  due  to  the  incident  he  re- 
members distinctly  of  the  funeral  of  his  grandmother, 
but  does  not  remember  his  grandmother  herself.  Says 
his  dreams  are  mixed  up  with  death  and  funerals. 
The  hymn  was:  "Is  my  name  written  there.'*"  which 
had  to  do  with  patient's  testing. 

The  place  of  fear  of  the  grandmother  where  he  was 
at  the  funeral,  that  place  was  a  "huge  hole."  This 
probably  helped  the  formation  of  fear  of  funerals, 
also  dreams  of  burials  and  resurrections. 

Had  a  dream  about  salvation.  Evidently  the  sub- 
conscious still  retains  the  prejudices.  Also  dreamt 
of  the  death  of  a  friend  of  his.  The  dream-experience 
is  of  the  supernatural.  He  thinks  that  there  is  an  ex- 
perience which  he  has  forgotten,  which  may  account 
for  the  whole  thing.  Thinks  he  had  something  of  the 
terrible  in  it,  had  great  mental  ^Herror."  He  reminded 
himself  that  when  about  six  years  he  had  fearful  "shak- 


230     Causation  and   Treatment^  Psychopathic  Diseases 

ingj'^terrors^on  awakening.  Used  to  call  them  "shaking 
spells,"  his  folks  used  to  call  it  the  same  way. 

Father  corroborated  the  patient's  story  of  his  spells 
due  to  fears. 

Begins  to  dream  about  testing  in  sleep.  Being 
aboard  on  ship,  listening  to  bells. 

Dreams  much  of  death.  Dreamt  of  the  death^of  a 
friend  of  his  who  died  just  about  the  time  when  patient 
was  in  bad  condition.  Dreamt  that  he  was  to  be  bur- 
ied, and  still  was  alive.  The  whole  patient's  life  hinges 
on  death  (experiences  of  life  after  death).  Something 
flashed  in  his  mind:  "The  world  burnt  up!  People  lie 
in  the  ground  a  long  time  before  resurrection."  His 
whole  childish  system  is  built  on  life  after  death,  sal- 
vation, damnation. 

Feels  strain  in  the  presence  of  strangers,  thinks  lacks 
vitality.  The  knowledge  of  the  history  of  his  case  not 
sufficient,  must  allay  fears  by  other  considerations. 
Tells  me  he  does  not  feel  any  more,  as  if  he  is  a  lost  soul. 

Dreamt  of  death  of  aunt,  looked  into  casket,  body 
alive,  moved,  felt  anxiety,  when  woke  up  had  words 
"B.  M. "  name  of  his  old  early  Sunday  school  teacher 
who  influenced  him  strongly  in  his  religious  life. 

The  details  of  the  "dream  death"  keep  on  varying. 
Had  experience  of  funerals,  saw  one  brought  out  through 
window,  because  the  door  was  too  narrow. 

The  "test  dream"  which  he  has  besides  the  "funeral 
dream"  is  more  depressing  than  the  "funeral  dream," 
because  the  first  deals  with  himself,  the  second  with 
others,  and  yet  both  are  connected  with  his  general 
fear  of  damnation. 

I  have  to  discuss  with  him  on  "sin,"  "suffering," 
"adjustment  to  life,"  and  other  metaphysical  and 
theological  subjects.  Alphabet  is  expressed  to  him  in 
number.     Has  attacks  when  the  testing  comes. 

Has  dreams  of  false  recognition,  saw  friends  whom  he 


Psychognosis  of  Psychopathic  Cases  231 

recognized  in  dream  having  known  them,  turned  out  he 
had  never  seen  those  faces. 

Patient  begins  to  improve,  indifferent  to  testing  for 
some  intervals. 

Feels  well  after  a  series  of  relapses;  but  dreams  about 
Waverly  and  does  testing,  wakes  up  with  relief.  Be- 
gins to  experience  enthusiasm  about  his  work. 

After  a  couple  of  years  of  persistent  treatment  by 
means  of  the  hypnoidal  state  and  methods  of  associa- 
tion and  disintegration  of  the  active  subconscious 
systems,  the  patient  recovered.  He  entered  a  well- 
known  medical  school  and  took  a  high  rank  among  the 
medical  students. 


Ill 

The  following  history  is  an  account  written  by  the 
patient : 

"  I  propose  here  to  put  down,  as  far  as  memory  serves 
me,  a  detailed  account  of  my  early  impressions  which 
resulted  later  in  a  very  troublesome  mental  condition. 
My  recollections  of  this  early  period  are  rather  hazy. 
As  I  remember  it,  the  first  person  to  present  religious 
themes  to  my  mind  was  an  ignorant  woman  who  lived 
about  one  hundred  yards  from  the  home  where  I  was 
born  and  brought  up.  She  was  a  middle-aged  or  elderly 
housewife  who  had  a  crudely  religious  turn  of  mind. 
She  used  to  hold  family  prayer  meetings  where  prayers 
were  said  and  hymns  sung.  This  woman  was  a  great 
smoker  of  a  blackened  clay  pipe.  It  was  principally 
through  her  grandchildren  that  I  became  acquainted 
with  her.  In  her  efforts  to  bring  her  grandchildren  up 
in  the  straight  and  narrow  way  she  quite  naturally 
sought  to  include  their  young  friends  of  whom  I  was 
one. 


232     Causation  and   Treatment^  Psychopathic  Diseases 

"According  to  my  memory,  the  very  first  time  that 
this  woman,  or  anybody  else,  broached  rehgious  sub- 
jects to  me  was  one  morning  when  I  was  in  her  house. 
I  will  relate  the  exact  incident  as  my  somewhat  foggy 
memory  recalls  it.  I  had  gone  into  her  house,  for  what 
reason  I  have  no  idea.  She  asked  me  if  I  sup- 
posed I  should  always  go  on  living  just  as  I  was.  I 
suppose  I  said  'y^s.'  She  said  'no,'  and  then  went  on 
to  tell  me  of  death.  Had  she  stopped  at  that,  it  would 
have  not  been  so  bad,  but  she  went  on  to  tell  me  all 
about  the  rising  from  the  dead  and  the  frightful  judg- 
ment which  followed.  The  good  went  to  heaven,  of 
course,  but  the  wicked  (as  I  remember  it  'wicked' 
was  a  favorite  word  of  hers)  were  burned  up.  Of 
course,  painful  fire  and  brimstone  were  to  be  visited  on 
the  'wicked.'  From  what  I  know  of  the  woman's 
character,  I  have  no  doubt  she  added  to  the  grewsome 
tale  many  a  hair-raising  detail,  but  I  do  not  definitely 
remember  much  of  these.  I  do  remember  one  thing 
plainly;  she  said  those  who  went  to  heaven  would  not 
be  able  to  take  their  money  or  their  goods  with  them. 
My  old  schoolhouse  was  directly  opposite  this  woman's 
house  and  I  have  a  dim  recollection  of  being  in  the 
playground  of  the  school  very  soon  after  my  conversa- 
tion about  the  future  life  and  still  thinking  over  the 
situation.  It  is  hard  for  me  to  say  how  old  I  was  at 
this  time,  but  I  should  estimate  five  years. 

"I  suppose  the  woman's  doctrine  was  perpetuated,  if 
not  amplified  by  the  grandchildren  and  other  proselytes 
who  received  it  at  the  same  time  that  I  did.  My 
brother  in  particular,  who  was  four  years  older  than  I, 
I  think  was  impressed  by  the  current  religious  doctrine 
and  he  naturally  might  have  thought  it  his  bounden 
duty  to  instruct  me. 

"Another  source  from  which  I  imbibed  of  a  similar 
decoction  of  ideas  is  my  early  Sunday  school.     The 


Psychognosis  of  Psychopathic  Cases  233 

influences  which  I  came  under  were  undoubtedly  more 
generally  intelligent,  but  the  theological  doctrine  was, 
I  think,  not  cheerful  to  a  child's  mind. 

My  Sunday  school  days  do  not  leave  a  pleasant  flavor 
in  my  mind.  I  have  a  Bible  that  was  presented  to  me, 
for  committing  to  memory  the  Ten  Commandments,  by 
the  Sunday  school  teacher.  I  was  just  eight  years  old 
at  the  time  this  Bible  was  given.  I  know  this  positively 
by  the  inscription  in  the  front.  I  think,  however,  my 
Sunday  school  career  had  preceded  this  by  some  years. 
Through  this  period  my  idea  of  religion  was  a  night- 
mare to  be  kept  in  the  background  as  far  as  possible. 
The  whole  purpose  of  life  was  to  escape  hell  at  the  end. 

' '  I  cannot  be  sure  of  what  I  am  about  to  say,  but  it  is 
my  impression  that  so  far  as  I  broached  to  my  family 
my  ideas  of  the  dreadful  doctrine,  they  did  not  attempt 
to  rid  my  mind  of  it.  I  was  naturally  rather  secretive 
with  my  thoughts  and  they  had  no  means  of  knowing 
the  damage  that  was  being  done.  They  probably  took 
it  as  an  evidence  of  early  piety,  and  thought  it  was  more 
or  less  healthy. 

"Another  source  from  which  I  imbibed  some  'ortho- 
dox' doctrine  was  that  of  revival  and  evangelical  meet- 
ings which  were  sometimes  held  in  the  hall  over  my 
father's  store  and  other  places.  There  was  in  particu- 
lar one  woman  evangelist  who  used  to  come  around 
occasionally,  preaching  the  immediate  ending  of  the 
world  and  the  day  of  judgment.  I  think  she  some- 
times had  the  exact  date  figured.  While  my  family 
ridiculed  this  woman,  and  had  but  little  sympathy  with 
the  other  evangelistic  seances,  still  I  was  more  or  less 
impressed  with  the  possibility  of  there  being  some 
truth  in  the  matter.  With  so  dreadful  a  thing  as  hell 
in  the  balance,  any  possibility  at  all  was  enough  to 
make  one  take  notice.  I  remember  that  one  day  this 
woman  evangelist   (she  was  a  Seventh-day  Adventist) 


234     Causation  and   Treatment,  Psychopathic  Diseases 

undertook  to  prove  to  my  father  in  my  presence  the 
date  on  which  the  world  would  end.  She  took  certain 
numbers  from  the  Bible  and  apparently  made  certain 
combinations,  the  result  of  which  proved  conclusively 
that  the  day  of  judgment  was  at  hand, 

"In  all  my  early  religious  experiences  it  was  always 
the  doctrine  of  hell  that  stuck  in  my  ears.  Everything 
else  was  so  insignificant  that  it  made  little  impression 
in  comparison.  I  am  inclined  to  believe  that  this  fear 
was  gradually  stamped  on  my  mind.  I  do  not  think  it 
was  due  to  any  single  impression  or  impressions.  First 
came  the  old  woman's  doctrine,  the  woman  who  smoked 
the  pipe,  this  was  confirmed  probably  by  her  grand- 
children and  other  playmates  who  had  received  the 
same  ideas  from  her  or  others  of  her  stamp,  then  my 
home  and  Sunday  school  teaching,  and  last  of  all  the 
revival  meetings. 

"One  abnormal  trait  of  my  childhood  was  the  undue 
fear  and  emotion  which  the  absence  of  my  family 
caused.  Unless  the  entire  family  was  involved,  the 
emotion  was  very  much  reduced,  if  not  altogether  done 
away.  The  fear  was  that  some  terrible  accident  could 
happen  to  them,  and  that  I  should  be  left  alone.  In 
this  emotion  a  certain  sense  of  mystery  was  required, 
generally,  to  have  a  strong  effect.  If  I  knew  just 
where  my  family  were  and  whom  they  were  with,  this 
emotion  was  greatly  reduced.  I  think  the  most  excit- 
ing thought  was  one  of  disappearance  rather  than  of 
accident,  a  vague  notion  that  once  my  folks  were  out  of 
reach,  even  for  an  hour  or  less,  they  might  in  some 
mysterious  way  disappear  and  I  would  be  unable  to 
find  them  or  trace  them.  As  I  have  said,  if  one  member 
of  the  family  (there  were  three  altogether,  father, 
mother,  and  brother)  was  still  with  me,  then  the  ex- 
citement was  very  much  lessened,  though  there  was 
still  an  abnormal  concern  lest  something  should  happen 


Psychognosis  of  Psychopathic  Cases  235 

to  the  absent  one  or  ones.  However,  then  I  should 
not  be  left  a  lonely  survivor.  And  again  the  emotion 
was  much  less  if  some  acquaintance  was  with  them  in 
their  absence,  for  then  they  could  be  traced.  In  this 
way  the  idea  of  mysterious  disappearance  was  more 
or  less  disabled,  for  mysterious  disappearance  did  not 
apply  to  anybody  but  my  father,  mother,  and  brother. 

"Naturally,  other  things  being  equal,  these  emotions 
concerned  themselves  more  strongly  with  my  parents 
than  my  brother,  I  have  spent  many  hours  of  anxiety 
in  the  country  school  where  we  lived  worrying,  lest  I 
should  find  the  house  empty  when  I  got  home  from 
school.  Of  course,  frequently  my  folks  would  be  out, 
then  the  immediate  task  was  to  locate,  if  possible, 
where  they  had  gone,  by  examining  the  wheel  tracks 
out  from  the  stable,  asking  neighbors,  etc.  To  know 
where  they  had  gone,  even,  was  a  gain.  This  abnormal 
habit  of  mind  was  very  persistent.  It  gave  me  no  little 
trouble  when  I  was  in  the  'teens,  and  to  this  day  it  will 
sometimes  crop  out  as  an  emotional  anachronism. 

"For  a  time  in  childhood  I  had  the  obsession  that  I 
could  not  swallow  beefsteak.  If  I  chewed  potato, 
however,  at  the  same  time  with  the  steak,  I  had  no 
difficulty.  If  I  went  out  to  visit  with  my  parents  and 
steak  was  served,  unless  potatoes  were  promptly  served 
along  with  it,  there  might  be  trouble  at  the  table.  For 
a  period  in  childhood  and  again  for  another  period  at 
about  twelve  or  thirteen  years,  I  had  a  morbid  fear  of 
poison,  a  fear  carried  to  fantastically  absurd  lengths. 

"At  the  age  of  eleven  or  before,  I  began  to  be  troubled, 
for  the  first  time,  with  a  perfectly  definite  religious 
fear.  Hitherto  my  religious  fears  had  been  general. 
At  the  time  I  began  to  fear  that  I  had  committed  what 
the  Bible  speaks  of  as  the  unpardonable  sin  or  blas- 
phemy against  the  Holy  Ghost.  I  had  actually  made 
some   remark  about  God  which   I   afterwards  feared 


236     Causation  and  Treatment,  Psychopathic  Diseases 

might  be  blasphemy.  Here  was  a  definite  reason  why 
I  should  be  damned.  All  other  sins  could  be  forgiven, 
but  never  this.  At  this  time  I  think  I  was  eleven  and 
a  half  years  old.  My  mental  disturbance  at  this  time 
was  great.  This  particular  idea  persisted  for  a  long 
time,  but  now  other  ideas  began  to  crowd  in  thick  and 
fast  even  before  this  one  disappeared,  all  leading  up  to 
the  same  ultimate  fear,  damnation. 

"There  were  many  different  theories  formed  as  to 
why  I  was  in  danger  of  damnation  between  the  age  of 
eleven  and  sixteen,  A  playmate  of  my  early  life  had 
died  of  a  somewhat  mysterious  disease.  I  used  to  tease 
her,  and  now  I  feared  that  in  some  way  I  might  have 
caused  her  death  and  was  a  murderer.  In  my  morbid 
fear  of  poison  I  had  subjected  other  people  to  frightful 
risks  of  being  poisoned  to  death.  My  early  sexual 
imaginings  perhaps  had  been  a  deadly  sin.  The  ideas 
in  connection  with  poison  were  very  troublesome  in  this 
connection.  I  did  not  suppose  I  had  actually  poisoned 
anybody,  but  since  poison  was  on  my  clothes,  hands, 
and  possessions,  I  was  constantly  subjecting  the  people 
around  me  to  great  danger,  and  I  did  not  have  moral 
courage  enough  to  warn  them  of  this  danger,  because 
I  had  a  sort  of  idea  the  poison  theory  was  foolish. 
Still  this  lack  of  courage  to  warn  them  was  a  source  of 
untold  anxiety,  lest  on  account  of  it  I  should  be  doomed. 
I,  of  course,  knew  the  danger  of  poison  and  could  and 
did  avoid  it,  but  to  endanger  the  lives  of  poor  unsus- 
pecting people  was  a  hideous  crime.  I  cannot  re- 
member all  the  theories  that  entered  my  mind  leading 
to  the  fear  of  hell.  They  were  manifold.  When  I  was 
sixteen  the  foremost  one  was  a  fear  that  my  faith  was 
not  sufficient  for  salvation. 

"This  fear  of  lack  of  saving  faith  very  soon  gave 
place  to  a  general  idea  which  proved  to  be  permanent. 
The  idea  was  this:  that  if  I  was  called  upon  for  an 


Psychognosis  of  Psychopathic  Cases  237 

exercise  of  great  self-sacrifice  for  some  very  great 
necessary  purpose,  my  moral  courage,  or  perhaps 
physical  courage  is  the  better  term,  would  prove  so 
far  below  the  required  standard  that  in  consequence 
I  should  be  condemned.  Whether  the  occasion  for  a 
display  of  sacrifice  arose  or  not,  I  felt  that  the  weak- 
ness was  present.  I  argued  that  as  a  rotten  rope  is 
just  as  weak  whether  it  is  ever  pulled  or  not,  it  did 
not  matter  whether  I  failed  to  sacrifice  in  a  definite  case 
or  whether  simply  the  weakness  existed.  I  could 
easily  think  of  numberless  experiences  at  which  my 
courage  stood  still  and  shuddered.  To  be  sure,  there 
was  no  probability,  perhaps  no  possibility,  of  my  being 
called  on  to  choose  such  an  experience,  but  suppose 
some  enormously  great  cause,  outside  of  myself,  should 
demand  such  a  sacrifice,  some  cause  so  infinitely 
greater  than  my  bit  of  suffering  that  the  two  could  not 
be  compared.  This  fear  of  lack  of  faith  and  courage 
tortured  me. 

"During  an  attack  of  measles,  contracted  in  college, 
my  mental  suffering  was  acute. 

"Having  once  initiated  the  principle  of  receiving 
supernatural  information,  the  means  of  applying  this 
system  had  no  bounds  other  than  lack  of  ingenuity. 
At  first  the  omens  were  not  significant  unless  the  nature 
of  them  had  some  apparent  meaning,  having  to  do  with 
damnation.  But  after  a  time  this  property  of  direct 
significance  was  not  necessary  to  make  the  omen  valid. 
For  instance,  a  few  months  after  I  had  got  over  my 
attack  of  measles,  I  made  the  following  test:  I  said, 
mentally,  that  if  several  people  (designating  the  particu- 
lar ones)  of  the  persons  who  were  coming  to  the  hotel 
where  I  was  living  should  arrive  on  a  Tuesday,  I  would 
regard  it  as  possibly  a  revelation  confirming  my  fear. 
Of  course,  I  recognized  that  there  was  not  the  slightest 
connection  between  the  arrival  of  persons  at  the  hotel 


238     Causation  and  Treatment,  Psychopathic  Diseases 

and  my  salvation.  I  simply  figured  this  method  as 
an  arbitrarily  arranged  means  of  conveying  informa- 
tion from  some  spiritual  individuality  to  my  individual- 
ity, just  as  the  dots  and  dashes  of  telegraphy,  meaning- 
less in  themselves,  have  a  purely  arbitrary  meaning. 
As  a  matter  of  fact  the  first  two  arrivals  at  the  hotel 
that  I  had  put  in  the  test  did  come  on  Tuesdays, 
though  I  had  made  the  test  weeks  before  they  came,  not 
knowing  anything  at  all  about  their  plans  beyond  the 
simple  fact  that  they  were  coming.  In  the  case  of 
one  arrival,  I  had  one  chance  in  seven  of  getting  it 
right  by  coincidence,  and  as  I  hit  the  first  two,  the 
chances  were  one  in  forty-nine  that  it  might  have 
been  mere  chance.  This  caused  another  period  of 
intense  mental  distress,  but  another  one  of  my  arrival 
tests  failing,  I  was  immensely  relieved  and  assumed  as 
well  as  I  could  that  the  other  hits  had  been  merely 
coincidence. 

'*The  tremendous  emotions  raised  by  these  stormy 
periods  stamped  the  tendency  so  deeply  in  the  brain 
that  the  deadly  habit  was  slowly  getting  a  firm  hold 
on  my  mental  life.  The  word  'deadly'  is  not  too 
strong  to  apply  to  this  tendency,  for  it  has  been  a 
withering  blight  on  other  activities. 

"I  became  afraid  to  go  much  away  from  home,  or 
at  least  to  get  out  of  touch  with  home,  for  the  fear 
connected  with  the  testing  had  been  a  terrible  thing 
even  when  I  had  been  surrounded  by  my  family  and 
friends,  what  would  it  be  if  I  had  to  meet  it  with  only 
my  own  mental  resources  which  were  absolutely  de- 
moralized.'' The  presence  of  my  own  people  and  inti- 
mate friends  who  tried  to  show  me  the  error  of  my 
fears  was  a  great  palliative,  even  though  they  could  not 
absolutely  persuade  me  that  I  had  nothing  to  fear. 
":.  "This  habit  of  omen  testing  has  had  a  monstrous 
growth,  continuing  into  the  present.     As  to  the  details 


Psychognosis  of  Psychopathic  Cases  239 

of  arranging  the  tests,  without  exaggeration,  it  would 
take  volumes  to  report  them,  for  they  have  been  inter- 
minable and  constantly  changing.  They  have  been 
concerned  with  the  letters  in  my  reading,  with  people 
walking  on  the  street,  with  carriages  and  automobiles, 
fire  alarms,  sounds  of  all  kinds,  even  the  sound  of  the 
voice  and  of  birds,  hymns  in  church,  the  weather,  the 
arrangements  of  letters  in  conversation,  etc.,  etc. 
Having  accepted  the  principle,  it  has  been  simply  a 
matter  of  ingenuity  to  apply  it  to  any  form  of  activity 
or  inactivity  whatsoever,  and  if  the  variety  and  intri- 
cacy of  this  testing  system  is  any  measure  of  ingenuity, 
I  have  good  reason  to  be  well  puffed  up  with  conceit. 

"The  general  principle  has  been  the  same  throughout, 
which  is,  briefly,  this:  If  the  normal  course  of  events 
is  interfered  with  in  the  special  way  that  I  arbitrarily 
arrange  in  my  mind,  before  the  happening,  I  infer,  or 
rather  fear,  that  it  is  a  signal  from  some  extraneous 
intelligence.  As  to  a  signal  of  what,  that  also  is  arbi- 
trarily arranged  beforehand.  For  instance,  I  considered 
it  was  not  the  normal  course  of  events  for  me  to  be  able 
to  predict  on  what  day  of  the  week  several  people 
would  arrive  at  the  hotel,  for  I  feared  either  that  I  had  a 
supernatural  power  of  prediction  or  that  the  people 
themselves  were  in  some  supernatural  way  forced  to 
fall  in  with  the  day  I  had  predicted. 

"This  testing  went  on  with  varying  intensity  from  the 
time  it  started  at  the  age  of  about  nineteen  or  twenty 
and  is  still  continuing  in  one  way  and  another.  During 
these  years  my  activities  have  been  greatly  hampered. 
I  have  stood  in  such  fear  that  I  have  spent  my  time  for 
the  most  part  with  my  family,  dreading  to  take  any 
step  at  all  that  would  increase  my  emotion.  Any 
definite  idea  of  starting  out  on  a  career  of  any  kind 
has  never  even  been  seriously  entertained.  I  have 
realized  that  the  problem  has  only  been  dodged,  not 


240     Causation  and  Treatment,  Psychopathic  Diseases 

settled,  by  this  course,  but  it  was  better  to  stay  in  the 
frying  pan  than  to  jump  into  the  fire. 

"After  all,  T  date  the  last  and  present  phase  of  my 
troubles  from  last  May,  just  about  a  year  ago.  At  the 
beginning  of  May  a  year  ago  I  was  in  fairly  good  con- 
dition for  me.  I  was  not  aware  that  my  mental  dis- 
order was  very  different  from  what  it  had  been.  To 
be  sure,  I  had  observed  that  the  testing  had  been 
growing  more  extended  and  troublesome,  but  there  had 
been  times  in  the  past  when  it  had  been  extremely 
troublesome. 

"I  will  describe  in  detail,  as  well  as  possible,  the 
beginning  of  the  last  stage  in  this  miserable  business. 
I  was  destroying  some  old  letters  one  morning  which 
I  had  had  stowed  away  for  years.  They  were  in  tied- 
up  packages,  each  letter  dated  on  the  back.  A  strong 
idea  of  making  tests  on  those  dates  suddenly  took 
possession  on  my  mind,  so  I  took  one  of  the  packets 
of  letters  and  predicted  whether  the  date  on  the  top 
letter  would  be  an  even  or  an  odd  number.  Having 
hit  the  top  number  right,  I  continued  down  through  the 
packet,  and  it  was  some  little  time  before  I  made  a 
failure,  though  there  was  apparently  no  natural  means 
whatsoever  by  which  I  could  foresee  the  dates.  I  had 
not  looked  over  these  letters  in  years,  and  there  was 
no  systematic  arrangement  as  to  dates  anyhow.  It 
might  have  occurred  by  coincidence,  but  the  chances 
were  large  against  this.  This  circumstance  aroused  a 
good  deal  of  apprehension  and  as  usual  in  such  cases, 
gave  the  testing  fresh  impetus. 

"I  began  immediately  to  make  other  tests  some  of 
which  seemed  to  defy  the  laws  of  chance.  Within  a 
day  or  two  I  had  a  result  in  testing  on  the  dates  of 
some  post-marks  which  to  this  day  I  regard  as  phe- 
nomenal. At  this  time  nearly  all  the  testing  was 
done  on  things  where   the  chances  were  about   even 


Psycho  gnosis  of  Psychopathic  Cases  241 

of  my  hitting  or  missing,  therefore  it  was  not  the 
individual  times  that  the  test  came  out  as  I  had  pre- 
dicted that  made  the  impression  on  my  mind,  it  was 
the  series  which  piled  in  succession.  This  odd  and 
even  testing  was  the  result  of  a  long  evolution.  At 
first  I  made  tests  where  the  chances  of  my  getting  them 
right  by  ordinary  coincidence  were  very  much  smaller. 
There  were  plenty  of  individual  failures  now,  but  in 
spite  of  these,  there  were  results  that  I  could  hardly 
reasonably  attribute  to  chance.  I  got  new  points  of 
view,  which  I  had  not  had  before,  and  which  lead  me 
to  see  in  a  new  light  how  contrary  to  the  laws  of  chance 
my  testing  came  out.  And  now  my  testing  began  to 
branch  out  amazingly,  and  began  to  involve  all  my 
activities. 

"It  was  at  this  time  that  I  first  went  to  Dr.  P.  He 
asked  me  if  there  was  anything  that  I  would  like  espe- 
cially to  do,  and  I  told  him  I  should  like  very  much 
to  go  to  visit  some  friends  in  New  York.  He  said  "go 
and  come  back  here,  if  you  don't  feel  better."  It 
may  appear  strange  that  I  should  have  wanted  to  go 
away  from  home  at  a  time  when  my  emotions  were 
most  aroused.  The  explanation  is  this:  I  had  been 
visiting  these  same  people  in  New  York  the  preceding 
winter,  and  had  grown  to  be  very  fond  of  them.  They 
were  intimate  friends,  so  much  so  that  they  seemed 
more  like  my  own  family  than  mere  friends.  There- 
fore, T  was  rather  going  from  one  home  to  another  than 
going  away  from  home,  and  moreover,  the  home  I  was 
going  to  had  apparently  been  better  adapted  to  my 
mental  state,  for  I  had  got  along  there  better  than  I 
was  now  getting  on  at  York  Harbor,  my  permanent 
home. 

"I  did  not  have  the  courage  to  make  even  the  short 
railway  journey  to  New  York  alone,  but  insisted  on 
my  mother's  going  along.     She  did  so  and   returned 


242     Causation  and  Treatment^  Psychopathic  Diseases 

in  a  few  days,  leaving  me  with  my  friends.  At  first 
the  change  seemed  to  agree  with  me,  but  only  very 
briefly.  I  now  went  rapidly  from  bad  to  worse,  and 
my  mental  suffering  became  really  terrible.  It  was 
the  same  fear  of  supernatural  suffering  intensified.  I 
was  in  New  York  nearly  a  month,  growing  worse.  I 
was  simply  a  mental  fragment  of  myself.  Activity 
was  pretty  much  at  a  standstill,  though  sometimes  after 
suffering  the  limits  of  agony,  there  would  be  a  mental 
reaction  and  I  would  feel  better  temporarily.  The 
whole  theme  of  the  trouble  was  fear-testing.  New  forms 
of  this  arose.  At  this  time  one  of  the  most  trouble- 
some forms,  which  had  its  beginning  then,  was  a  test 
on  sounds  with  respect  to  the  inhalation  or  exhalation 
of  my  breath.  If  sounds,  such  as  whistles,  bells,  or  any 
other  arbitrary  sounds,  reached  my  ear  at  that  period 
of  the  respiration  that  I  had  predicted  it  would  come  at, 
it  was  ominous  to  me  and  intensified  my  fear.  Some- 
times I  had  almost  paroxysms  of  fear  at  the  times  when 
the  tests  seemed  to  be  certainly  directed  by  some  intelli- 
gence other  than  my  own.  My  friends  were  good 
to  me,  and  without  the  presence  of  some  people  like 
these  or  my  own  folks,  I  cannot  imagine  how  I  could 
have  got  through  such  a  period.  I  say  period,  but  it 
was  simply  the  beginning  of  trouble. 

"In  June  my  brother  came  to  New  York  and  took 
me  home.  Here  my  sufferings  continued.  Still  newer 
forms  of  testing  arose  which  restricted  my  activity 
still  more.  All  manner  of  work  I  renounced,  and  as  for 
recreation,  the  testing  and  great  suffering  put  a  stop 
to  that.  Sometimes  I  lay  in  bed  nearly  all  day,  for 
there  was  nothing  else  I  wanted  to  do,  and  furthermore, 
I  could  get  away  from  testing  better  this  way,  for  I 
would  not  have  to  see  any  printed  letters,  and  I  could 
muffle  my  ears  somewhat  with  the  bedclothes  to  pre- 
vent my  hearing  sounds  to  test  on.     It  is  impossible 


Psychognosis  of  Psychopathic  Cases  243 

to  convey  to  the  mind  of  any  individual  the  horror  and 
agony  that  I  experienced.  To  say  that  I  was  beset 
with  extreme  fear  means  nothing  to  the  normal  person's 
mind,  for  the  greatest  fear  he  can  clearly  imagine  is 
perhaps  to  be  chased  by  a  lion,  to  fall  off  Brooklyn 
Bridge,  to  lose  all  his  property,  or  to  lose  some  dear 
friend  by  death.  Any  of  these  are  calamities,  but  to 
compare  them  with  the  wild  terror  which  I  felt  makes 
them  insignificant. 

"This  state  of  affairs  continued  till  some  time  in 
July,  when  my  consent  was  most  reluctantly  obtained 
to  go  to  the  McLean  Hospital,  at  Waverly.  My  brother 
had  been  advised  by  Dr.  P.  that  I  should  go  to  a  hospital 
(afterwards  Dr.  P.  said  Waverly  would  not  have  been 
his  choice).  I  had  reached  such  a  state  of  despair 
that  the  prospect  of  having  something  done  for  me 
raised  a  faint  aura  of  hope  that  perhaps  I  could  be  re- 
lieved. Furthermore,  the  McLean  Hospital  did  not 
present  itself  to  my  mind  as  being  really  a  private 
insane  hospital.  Dr.  A.,  who  had  been  looking  after 
me  as  well  as  he  could  during  these  fearful  days,  had 
told  me  that  there  were  two  departments  at  the  hospital, 
one  for  insane  cases,  and  a  separate  one  for  nervous 
afflictions,  and  that  I  was  going  to  the  latter.  He 
said  distinctly  that  there  would  be  no  confinement. 
Perhaps  he  thought  he  was  telling  the  truth,  but  wheth- 
er or  no,  I  do  not  blame  him,  for  he  and  my  family 
were  at  their  wits'  end  and  were  completely  demoralized. 

"Accordingly,  one  bright  July  morning  I  started 
out  for  Waverly.  I  believe  it  is  the  Lady  Macbeth  who 
says  'So  foul  and  fair  a  day  I  have  not  seen.'  That 
is  not  inappropriate  here.  I  signed  a  voluntary  com- 
mitment somewhat  unsuspectingly.  Thirty  minutes 
after  I  had  signed  I  would  have  given  all  my  possessions 
and  much  more  if  I  had  not  signed.  My  brother  and 
one  of  my  New  York  friends  had  accompanied  me  to 


244     Causation  and  Treatment,  Psychopathic  Diseases 

the  hospital,  and  on  them  I  used  what  powers  of  argu- 
ment I  possessed  to  induce  them  to  believe  this  was 
not  the  place  for  me,  but  quite  naturally  they  took 
the  opposite  view.  I  spent  four  days  there.  It  is 
useless  to  attempt  to  describe  my  fear  agony  during 
this  period,  for  its  intensity  baffles  description.  Enough 
to  say  that  I  was  thrown  suddenly  on  my  own  resour- 
ces, unable  to  read  or  do  anything  else,  fearful  of  every 
whistle,  the  slamming  of  every  door,  made  tremen- 
dously afraid  by  conversation,  not  only  because  it  was 
a  sound,  but  from  the  arrangement  of  the  letters.  I 
would  walk  around  the  circle  of  the  yard's  liberty,  then 
lie  abed  as  long  as  I  could  stand  the  agony,  then  walk. 
I  doubt  if  I  was  sensible  to  ordinary  physical  pain  at 
this  time. 

"The  suffering  was  all  that  the  crude  conception 
of  the  inferno  would  ask  for,  therefore  the  feeling  grew 
that  it  was  hell  and  might  continue.  The  idea  of 
spending  a  lifetime  there  was  unendurable,  but  in  addi- 
tion to  that  I  was  afraid  that  I  should  be  unable  to  die, 
and  live  on  indefinitely,  get  to  be  sixiy,  seventy,  eighty, 
a  hundred  years  old,  and  still  not  relieved  by  death.  I 
doubt  whether  such  excess  of  mental  suffering  can  be 
experienced  without  leaving  permanent  scars  in  the 
nervous  system. 

"During  the  four  days  I  was  at  the  hospital  I  was 
writing  letters  home  which  were  couched  in  the  most 
urgent  phraseology  that  my  command  of  the  English 
language  permitted.  I  discovered  through  the  head 
nurse  of  my  ward  that  a  voluntary  patient  could  give 
notice  that  he  would  not  remain,  but  that  before  his 
discharge  his  people  must  be  communicated  with,  giving 
them  the  opportunity  to  have  him  legally  committed. 
I  was  afraid  to  insist  on  my  rights,  lest  I  should  be 
committed  by  law,  in  which  case  I  knew  my  chances 
of  regaining  liberty  would  be  very  much  reduced,  for  I 


Psychognosis  of  Psychopathic  Cases  245 

was  afraid  in  that  case  1  could  not  be  legally  liberated, 
even  with  the  consent  oi  my  people.  By  this  time  I 
had  little  doubt  that  I  was  insane,  though  this  realiza- 
tion did  not  make  my  fears  any  the  less  real  to  me. 

"My  father,  worried  to  death  by  the  character  of 
the  letters  I  was  writing,  sent  a  physician  friend  of  his 
to  Boston  to  see,  in  consulting  with  Dr.  J.  P.,  what  was 
best  to  be  done  in  the  matter.  Accordingly,  Dr.  H. 
and  Dr.  J.  P.  came  out  to  Waverly  together,  held  a 
consultation  with  the  McLean  officials,  and  decided 
that  I  should  be  removed  from  such  a  place.  I  there- 
fore went  home  with  Dr.  H. 

"My  relief  of  mind  at  getting  out  cannot  be  expressed. 
At  the  announcement  I  was  at  first  suspicious  that  Dr. 
H.  might  be  deceiving  me,  then  I  was  afraid  that  some 
unlooked-for  contingency  would  yet  prevent  my  get- 
ting out.  It  was  not  till  I  was  outside  the  bolts  and 
bars  that  I  felt  absolutely  sure  of  release.  During  this 
period  at  Waverly  nearly  everyone  showed  me  con- 
sideration and  kindness,  particularly  the  head-nurse  of 
my  ward  who  was  one  of  the  most  gentlemanly  young 
men  it  has  been  my  good  fortune  to  meet. 

"After  going  home  my  mental  condition  was  the 
same  as  before  the  Waverly  venture.  My  sufferings 
were  terrific.  At  times  they  were  so  great  that  I  would 
do  nothing  but  toss  and  moan  on  the  bed.  Frequently 
after  the  exhaustive  emotions  of  the  day  I  would  be 
pretty  well  worn  out  by  bed-time,  and  the  sleepy  feeling 
of  unconciousness  creeping  on  was  the  greatest  pleasure 
of  the  day.  But  it  was  a  tragedy  to  wake  up  in  the 
morning  and  realize  that  it  would  be  fourteen  or  sixteen 
hours  before  I  could  have  unconsciousness  again. 

' '  In  October  I  may  safely  say  that  I  was  very  much 
improved  over  the  summer,  but  still  life  was  hardly 
worth  while  living,  and,  with  all  my  improvement,  I 
was  much  harassed  with  my  fears.    At  this  time  I  came 


246     Causation  and   Treatment^  Psychopathic  Diseases 

to  Dr.  Sidis,  under  whose  care  I  have  since  been.  With 
my  coming  to  Dr.  Sidis  this  autobiography  ceases.  I 
have  tried  to  present  an  outline  of  my  abnormal  mental 
history,  though  necessarily  I  cannot  represent  it  as 
vividly  as  it  has  been  present  to  my  mind,  and,  of 
course,  numberless  details  have  been  omitted.  From 
my  point  of  view  it  is  the  story  of  a  blighted  life;  not 
only  that,  but  a  recounting  of  suffering  of  the  first 
magnitude,  pain  such  as  I  believe  very  few  individuals 
are  ever  called  upon  to  suffer,  and  pain  which,  by  reason 
of  its  abnormality,  very  few  persons  can  appreciate." 
"In  this  case  the  fundamental  fear-instinct  intertwined 
with  the  religious  sense  of  the  mysterious,  trained  in 
early  childhood,  stands  out  clear  and  distinct.  The 
process  of  cure  was  by  means  of  the  hypnoidal  state 
and  by  a  long,  painstaking,  psychotherapeutic  process 
of  dissipating  the  sense  of  the  mysterious  and  disinte- 
grating the  complex  systems,  reared  on  the  basis  of  the 
fear  instinct  and  the  morbid  impulse  of  self-preser- 
vation." 


CHAPTER  XV 

PSYCHOGNOSIS   OF  THE   PSYCHOPATHIC   SUBSTRATUM 

THE  subconscious  working  of  the  fear  instinct 
is  clearly  revealed  in  the  following  psycho- 
pathic cases: 

Mrs.  A.  Age  43.  Family  history  is  good. 
Patient  has  always  been  in  good  physical  health. 
Married  eight  years  ago.  Has  two  children,  both  are 
well.  Patient  is  possessed  by  an  intense  fear  of  her 
husband  whom  she  suspects  of  some  heinous  crime. 
The  attacks  come  in  waves,  in  seizures  of  brief  dura- 
tion with  intense  excitement,  agonizing  fear,  palpita- 
tion of  the  heart,  chattering  of  teeth,  followed  by  a 
long  period  of  depression  and  worry.  When  near  her 
husband,  she  is  excited  and  full  of  agonizing  fear. 
She  feels  her  husband  must  have  committed  something 
awful.  "There  is  an  insurmountable  obstacle  between 
us;  what  it  is,  I  do  not  know."  When  finally  her 
husband  confessed  to  her  of  some  escapade  of  his  youth, 
she  was  for  a  time  quieted,  but  soon  the  fear  of  the 
mysterious  sin  or  crime  once  more  arose.  The  confes- 
sion did  not  satisfy  her.  "There  must  be  something 
more  beyond."  This  thought  keeps  on  coming  to  her 
mind.  "It  turns  like  in  a  circle,"  as  she  puts  it.  She 
herself  is  conscious  of  the  predominance  in  her  of  the 
sense  of  the  mysterious.  "Even  if  my  husband,"  she 
tells  me,  "should  confess  to  me  the  most  awful  of  crimes 
I  would  still  suspect  him  of  worse  ones.  There  is  some- 
thing mysterious.     Nothing  definite  can  satisfy  me." 

A  letter  from  the  patient  may  best  show  her  state  of 
mind:  "There  is  nothing  new  to  tell  you,  it  is  the  same 
old,  pitiful  story,  only  varied  a  little  from  day  to  day. 

247 


248     Causation  and  Treatment,  Psychopathic  Diseases 

I  have  no  rest,  not  a  moment's  peace  of  mind.  I  lie 
awake  for  hours  at  night,  sometimes  the  whole  night, 
and  my  days  are  full  of  anguish  and  unrest.  I  am  not 
able  to  do  anything,  not  even  to  read  a  newspaper.  I 
am  truly  a  crushed  and  heartbroken  woman,  and  would 
almost  be  willing  to  give  up  the  struggle  were  it  not  for 
the  dear  little  children  who  are  dependent  on  me.  I 
also  want  to  do  my  duty  toward  my  husband.  The 
question  often  arises  in  my  mind:  'What  is  my  duty 
under  these  excruciating  circumstances.^  Must  I  stay 
here  and  suffer  through  the  long  days  and  longer  nights 
when  there  is  a  way  of  escape  .f"  Of  course,  it  is  my 
duty  to  stay,  but  I  can  assure  you  that  my  courage  is 
taxed  to  the  uttermost.  I  do  not  like  to  cut  my  hus- 
band adrift  now  that  he  needs  me  most,  yet  on  the  other 
hand  when  I  am  suffering  like  that  I  fail  in  all  the  duties 
of  life." 

In  another  letter  she  writes:  "I  suffer  intensely  all 
the  time  and  there  are  times  when  I  become  abso- 
lutely frantic.  There  are  nights  when  my  lids  do  not 
close  for  a  moment  and  I  walk  the  floor  in  a  frenzy  of 
excitement.  I  cannot  endure  the  struggle.  I  would 
rather  be  dead  than  to  go  through  the  agony  I  have 
gone  through  the  past  three  weeks.  I  shall  undergo  the 
most  excruciating  physical  tortures  rather  than  submit 
to  this  intolerable  suffering." 

A  few  days  later  she  writes:  "My  husband  went 
away  four  days  ago,  parting  with  me  under  circumstan- 
ces too  sad  to  be  expressed.  Since  he  left  me  I  have 
not  been  nervous  or  excited,  but  I  have  been  lonely  and 
broken-hearted,  and  in  a  state  of  almost  complete  col- 
lapse. Truly  my  situation  is  a  strange  one.  I  cannot 
live  with  my  husband,  and  life  seems  to  be  worth  noth- 
ing without  him." 

This  is  a  typical  psychoneurotic  case,  the  mental 
symptoms  stand  out  prominent  in  the  patient's  mind, 


Psychognosis  of  the  Psychopathic  Substratum      249 

the  physical  troubles  are  scorned,  nay  even  welcomed 
as  a  control,  as  a  relief  from  the  agony  of  fear.  The 
patient  manifests  the  inner  struggle,  the  strangeness  of 
the  situation,  mental  dissociation,  systematization  of 
the  symptom-complex  round  a  nucleus,  and  periodicity 
or  recurrence  of  the  psychopathic  states,  all  pathogno- 
monic of  psychoneurosis. 

We  may  turn  to  the  subconscious  dispositions  which 
form  the  genesis  of  psychoneurotic  states.  The  pa- 
tient had  a  strong  religious  training  with  a  profound 
belief  in  mysterious  agencies.  The  whole  family  has 
been  Christian  Scientists  for  years.  The  patient  was 
specially  imbued  with  the  belief  in  one  of  the  main 
dogmas  of  Christian  Science,  telepathic  suggestive 
influences.  She  has  faith  in  the  transmission  of  evil 
influences,  and  is  convinced  of  the  telepathic  powers  of 
death-thoughts  sent  by  wicked  minds,  possessed  of  spe- 
cial mental  capacities.  As  a  child  she  was  dreamy,  had 
a  love  of  the  mysterious,  and  obsessed  by  a  highly  de- 
veloped fear  of  the  unknown.  She  was  prone  to  fears 
of  an  imaginative  character  and  always  had  "the  fear 
of  the  Lord"  on  her.  The  world  was,  to  her  imagina- 
tion, peopled  with  spiritual  powers,  unseen  forces,  and 
mysterious  agencies  with  unlimited  possibilities  for  evil. 
Christian  Science  only  made  those  original  tendencies 
more  pronounced  and  more  intense. 

This  overwhelming  mass  of  associations,  dating  far 
back  to  early  childhood  has,  with  all  its  momentum, 
become  interrelated  with  her  emotions  in  regard  to  her 
husband.  This,  of  course,  should  be  expected,  since 
this  relation  was  the  most  important  in  her  life;  her 
subconscious  experiences  and  emotions,  by  the  psycho- 
logical law  of  assimilation,  became  transmitted  to  the 
mental  states  which  stood  most  prominently  in  her 
consciousness.     Thus  did  the  husband  get  the  whole 


250     Causation  and   Treatment,  Psychopathic  Diseases 

brunt  of  the  trouble.  He  formed  the  centre  round 
which  her  early  associations  became  crystallized. 

This  crystallization  was  helped  by  the  suggestive  in- 
fluence of  a  reader  of  one  of  the  Christian  Science  church- 
es, a  lady  who  was  in  love  with  the  patient's  husband. 
This  Christian  Science  reader  wrote  letters  to  the 
patient  and  her  father,  and  tried  in  all  ways,  by  direct 
and  indirect  suggestion,  to  influence  the  patient  and 
the  family  against  the  unfortunate  husband.  No  won- 
der that,  with  all  her  faith  in  the  mysterious  and  with 
all  her  early  training  in  the  belief  of  supernatural  agen- 
cies, the  patient  fell  an  easy  prey  to  the  suggestions  of 
her  rival. 

When  our  patient  found  out  that  the  "lady  reader" 
was  giving  her  "evil  influences,"  the  feelings  of  the 
mysterious,  centred  around  her  husband,  became  still 
more  emphasized  by  the  Christian  Science  belief  in  tele- 
pathic influences  and  transmission  of  death-thoughts. 
The  suspicions  in  regard  to  her  husband  became  still 
more  accentuated  and  more  developed  by  the  confes- 
sion made  by  the  patient's  husband  in  an  hour  of  trial 
that  he  had  had  a  liaison  with  a  lady  who  had  borne 
him  children.  This  shock  at  first  acted,  by  metathesis, 
as  a  modifying  control,  finally  resulting  in  the  fixation 
of  the  psychoneurotic  fear. 

The  following  letter  written  by  the  patient  best 
elucidates  the  whole  matter : 

"I  met  my  husband  about  four  years  before  I  married 
him,  though  our  actual  courtship  did  not  extend  over  a 
period  of  eight  or  nine  months,  and  I  doubt  if  there  was 
ever  a  more  unhappy  courtship.  It  began  with  an 
interesting  correspondence  which  continued  for  about 
two  or  three  months  after  which  we  met,  and  he  told 
me  of  his  love  for  me,  and  his  desire  to  marry  me. 
I  had  previously  grown  to  care  for  him,  and  the 
one  wish  of  my  heart  was  that  he  would  ask  me  to 


Psychognosis  of  the  Psychopathic  Substratum       251 

marry  him,  yet,  when  he  did  disclose  his  affection,  that 
very  moment  a  strange  and  unaccountable  thing  hap- 
pened to  me.  I  experienced  a  sudden  revulsion  of  feel- 
ing. I  began  to  think  there  was  something  dark  and 
forbidding  about  him,  and  I  flew  into  such  a  nervous 
panic  that  I  felt  obliged  to  go  away  a  few  days  later 
to  recover  my  equilibrium.  I  did  not  promise  to  marry 
him;  on  the  contrary,  I  told  him  that  I  didn't  think  I 
could,  and  I  meant  what  I  said.  The  day  after  I  left 
I  received  a  letter  from  him,  in  which  he  seemed  to  re- 
nounce all  hope  of  winning  me  for  his  wife.  It  was  the 
saddest  and  almost  the  most  beautiful  letter  I  ever 
read,  and  it  seemed  to  me  so  absolutely  sincere  and 
true,  that  I  was  completely  overcome  and  felt  that  I 
had  made  the  greatest  possible  mistake  in  not  giving 
him  more  encouragement.  I  sat  down  at  once  and 
wrote  him  reassuringly,  but  I  soon  found  myself  un- 
happy, and  in  a  state  of  indecision  again;  and  this  was 
the  history  of  our  courtship  from  beginning  to  end.  I 
could  not  give  him  up,  and  if  I  clung  to  him  I  was  still 
unhappy.  There  seemed  to  be  a  mysterious,  inevitable 
force  which  bound  me  to  him  in  spite  of  everything, 
and  almost  against  my  own  will,  or  so  it  seemed  at 
times.  I  felt  that  I  must  marry  him,  though  I  could 
foresee,  in  a  vague  sort  of  way,  the  perilous  path  ahead. 
The  conflict  was  terrible  and  in  this  state  of  mind,  I 
prayed  with  all  the  sincerity  and  deep  earnestness  of 
my  being  for  light  and  guidance,  and  a  voice  within 
whispered  'marry  him,'  and  I  was  thus  irresistibly 
drawn  into  marriage.  I  decided  that  when  we  were 
married  and  settled,  things  would  adjust  themselves, 
and  there  would  probably  be  no  further  trouble,  so  I 
arranged  to  be  married  as  soon  as  convenient. 

"Perhaps  I  should  say  at  this  juncture  that,  as  soon  as 
our  engagement  became  known,  there  was  open  and 
bitter  opposition  to  our  marriage  on  the  part  of  a  certain 


252     Causation  and  Treatment^  Psychopathic  Diseases 

person,  with  whom  we  had  both  been  friendly,  my 
husband  particularly  so.  She  did  everything  in  her 
power  to  prevent  the  marriage  and  almost  succeeded. 
She  made  such  insinuating  accusations  against  my 
husband,  that  my  father  felt  called  upon  to  make  a 
journey  of  several  thousand  miles  to  investigate  these 
charges.  After  several  interviews  with  her,  and  after 
seeing  my  husband,  he  became  convinced  that  she  was 
acting  from  purely  selfish  motives,  and  he  fully  believed 
in  the  integrity  of  my  husband.  I  had  every  confidence 
in  my  father's  judgment  and  believed  as  he  did  that  the 
whole  thing  was  a  conspiracy  to  break  up  our  marriage. 
That  problem  being  disposed  of  we  were  quickly  mar- 
ried, but  the  happiness  I  had  hoped  for  did  not  come  to 
me.  I  was  in  the  same  nervous,  apprehensive  state  as 
before  and  even  worse.  I  distrusted  my  husband  and 
had  vague  suspicions  of  him.  It  seemed  to  me  that 
he  had  done  some  dark  and  dreadful  thing  that  he  was 
concealing  from  me.  Sometimes  I  thought  that  he  had 
hypnotized  me  into  marrying  him.  I  believed  and  was 
encouraged  by  others  to  believe,  that  I  was  under  the 
hypnotic  control  of  the  woman  to  whom  I  have  referred, 
who  opposed  our  marriage.  At  any  rate,  I  had  no 
peace  of  mind.  Whenever  I  was  with  my  husband,  I 
kept  asking  him  again  and  again,  if  there  was  not  some- 
thing that  he  was  concealing  from  me.  He  said  'no.' 
"Finally,  one  day,  he  admitted  that  there  was  some- 
thing and  straightway  told  it  to  me.  I  was  very  much 
excited  over  this  avowal,  though  it  was  nothing  of  a 
dreadful  or  criminal  nature  as  I  had  supposed — nothing 
that  could  not  be  readily  forgiven,  and,  in  point  of  fact, 
I  felt  kindlier  to  my  husband  than  ever  before,  because 
I  knew  that  it  had  cost  him  something  to  make  this 
disclosure  to  me,  and  I  was  not  disposed  to  resent  too 
deeply  his  tenderness  in  so  doing.  Immediately  after 
this  my  health  seemed  to  improve  wonderfully,  and  I 


Psychognosis  of  the  Psychopathic  Substratum     253 

was  confident  that  it  was  the  fact  of  this  information 
being  withheld  from  me,  that  was  the  cause  of  all 
the  trouble  between  me  and  my  husband. 

"My  improvement,  however,  lasted  only  a  week  or 
ten  days,  at  the  end  of  which  time  I  found  myself  as  ner- 
vous as  before.  I  believed  that  my  husband  had  not 
told  me  all,  that  he  was  still  concealing  something  from 
me,  and  I  could  not  get  rid  of  these  ideas.  We  have  been 
married  almost  nine  years,  and  I  have  had  three  child- 
ren, two  of  whom  are  living.  During  these  nine  years 
we  have  lived  together  very  little,  and  have  never  been 
able  to  establish  a  home.  Somehow  I  have  clung  to 
my  husband  and  he  to  me  through  it  all,  though  at 
times  it  has  seemed  impossible,  but  'Hope  springs 
eternal  in  the  human  breast,'  and  so  great  was  my 
desire  to  hold  my  little  family  together,  that  I  would 
return  to  my  husband  again  and  again,  but  a  nervous- 
ness amounting  to  terror  always  seized  me  whenever 
I  was  with  him,  making  it  impossible  for  us  to  live  to- 
gether. 

"When  away  from  him  I  have  been,  if  not  happy,  at 
least  peaceful,  and  able  to  work  and  take  care  of  my 
children.  One  morning  about  two  months  ago,  some- 
thing unusual  happened.  I  received  the  news  of  the 
death  of  the  woman  to  whom  I  have  herein  referred. 
This  news  came  to  me  with  startling  surprise,  as  she 
was  a  comparatively  young  woman  and  I  could  not 
have  anticipated  her  death.  Almost  immediately  after 
that  I  felt  a  sense  of  freedom  and  noticed  a  change  in 
my  attitude  of  thought  toward  my  husband,  and  when 
he  was  with  me  recently  I  felt  decidedly  better,  though 
not  wholly  free  from  nervousness.  The  change  however, 
has  been  great  enough  to  cause  me  to  believe  that  I 
may  have  been — probably  have  been — the  victim  of  a 
long  continued  mental  attempt  to  wreck  my  home  and 


254     Causation  and   Treatment^  Psychopathic  Diseases 

happiness."      The    fear   soon   returned   with   renewed 
vigor.     The  patient  had  to  come  for  treatment. 

This  account  written  by  the  patient  gives  an  excellent 
insight  into  the  workings    of  the  psychoneurotic  mind. 

Mr.  M.,  twenty-one  years,  Russian.  The  patient 
was  referred  to  me  for  epileptiform  attacks  on  the  right 
side  of  the  body.  The  attack  is  of  the  Jacksonian  type. 
The  spasms  consisted  of  rhythmical  movements,  tonic 
and  clonic  contractures  of  the  head,  right  hand  and 
right  leg.  The  whole  right  side  was  affected  and 
anaesthetic.  The  attacks  come  annually,  about  the 
same  time  of  the  year  and  begin  always  at  midnight. 
Last  year  (1903)  the  patient  had  four  attacks.  Even 
a  few  weeks  after  the  attack  it  was  possible  to  discover 
a  diiference  in  the  sensibility  of  the  two  sides.  The 
attack  proper  lasted  from  a  few  hours  to  a  few  minutes 
and  even  seconds. 

The  patient,  as  it  is  typical  with  psychosomatic  cases, 
came  for  medical  treatment  of  his  physical  attacks, 
namely  his  convulsions  and  anaesthesia.  The  simula- 
tion of  Jacksonian  epilepsy  was  almost  perfect.  As 
soon,  however,  as  by  means  of  hypnosis,  we  began  to 
investigate  the  patient's  subconscious  life  the  whole 
history  and  origin  of  the  disease  became  revealed. 

A  psychognostic  examination  of  the  case  shows 
that  about  five  years  ago,  when  the  patient  was  six- 
teen years  of  age,  he  attended  a  ball  in  his  native 
town.  After  midnight  he  was  sent  out  to  look  for  a 
ring  which  he  had  lost  on  the  way  to  the  ball.  The 
patient  was  very  superstitious,  his  early  training  was 
saturated  with  beliefs  in  ghosts.  It  happened  that  on 
his  way  he  had  to  pass  a  cemetery;  he  got  frightened, 
it  seemed  to  him  that  somebody  was  after  him.  He 
fell  down  and  was  picked  up  in  an  unconscious  condi- 
tion and  brought  home.  It  is  from  that  time  that  his 
present    attacks    date.     The    attacks    reproduce    the 


Psycho  gnosis  of  the  Psychopathic  Substratum     255 

original    accident    as  well  as    the    condition    of    fear, 
convulsions  and  anesthesia  of  the  side  on  which  he  fell. 
During  the  attacks  he  keeps  on  dreaming  about  the 
fright,  fall,  and  about  his  illness.     In  short,  he  lives 
the  original  experience  over  again  in  his  subconscious 
dream  life.     While  examining  him  during  trance,  we 
happened  to  call  attention  to  his  anaesthesia.     Sud- 
denly, as  if  by  the  wand  of  a  magician,  his  past  personal- 
ity of  the  accident  emerged.     Mr.  M.  went  into  one  of 
his  attacks,  living  over  the  same  period  of  his  life  in 
Russia.     He  ceased  to  understand   English,  and  was 
carried  back  to  his  sixteenth  year.     He  cried  out  In 
great  agony,  as  of  one  frightened  to  death,  squirmed 
and  twitched,  and  began  to  shake.     "What  happened 
to  you.?"  he  was  asked.     "I  fell  down,"  he  exclaimed 
in  his   native  jargon:   "I  got  frightened."     He  then 
passed  through  the  movements  and  shaking  character- 
istics of  the  attacks.     When  asked  where  he  was,  he 
answered,  "At  home."     "With  whom  are  you  now?" 
"With  my  mamma."     When  the  attack  ceased,  with 
a  shudder,  he  literally  came  to  himself,   his  present 
personality  returned,  and  to  our  question,  "Where  are 
you?"  he  promptly  replied,  "At  the  doctor's."     Thus 
as  in  other  psychosomatic  cases,  an  investigation  re- 
veals the  presence  of  a  pathological  focus  of  a  purely 
psychic  origin  in  an  abnormal  impulse  of  self-preserva- 
tion, and  morbid  state  of  the  fear  instinct. 

The  following  cases  are  of  interest  on  account  of  the 
recurrent  fear  which  they  present. 

Mrs.  J.  A.,  age  thirty-eight.  Married.  Parents  of 
nervous  temperament.  Sister  is  well.  Patient  is  of 
Irish  descent,  born  in  United  States.  She  had  a  com- 
mon school  education,  and  is  not  very  intelligent. 

A  physical  examination  shows  the  patient  to  be 
poorly  nourished;  she  experiences  peculiar  noises  in  the 
right  ear,  and  when  she  falls  asleep  she  occasionally 


256     Causation  and  Treatment,  Psychopathic  Diseases 

hears  voices.  As  far  as  she  can  remember  this  per- 
sisted since  her  childhood.  Pupils  react  well  to  light 
and  accommodation;  patellar  reflexes  are  greatly  ex- 
aggerated. She  sees  spots  before  her  eyes  and  has  vivid 
visual  dreams.  Menstruation  normal,  regular,  and  not 
painful.  Sensibility  to  touch,  pressure,  pain,  and  tem- 
perature is  in  good  condition.  She  has  no  headaches, 
no  tremors,  no  motor  disturbances. 

Patient  complains  of  a  painful  and  very  distressing 
panophobia. 

The  patient  was  put  in  the  hypnoidal  state.  It  took 
some  time  to  quiet  her,  she  felt  intense  anxiety.  At 
last  she  became  soothed,  and  sank  into  a  deep  hypnoi- 
dal state;  but,  as  it  is  characteristic  of  this  state,  it  is 
varying  in  its  depth  from  moment  to  moment  and  is 
unstable.  The  instability  was  specially  characteristic 
of  this  patient,  on  account  of  the  nature  of  the  case. 
Still,  even  under  such  unfavorable  conditions,  the 
hypnoidal  state  yielded  some  definite  and  interesting 
results,  revealing  subconscious  systems  of  experiences 
which  gave  an  insight  into  the  nature  of  the  symptoms. 

The  patient  has  been  a  sensitive  and  nervous  child. 
She  liked  to  listen  with  trepidation  and  shivers  to  all 
kinds  of  stories  about  spirits,  hobgoblins,  and  ghosts, 
and  used  to  be  in  mortal  fear  of  evil  influences.  Dark- 
ness threw  her  into  great  fear,  because  she  suspected 
the  presence  of  all  kinds  of  mysterious  beings  and 
spirits,  especially  evil  ones.  She  used  to  hear  strange 
noises  in  her  ears,  and  was  afraid  of  them,  and 
ascribed  them  to  the  action  of  evil  agencies.  All  the 
dark  nooks  and  corners,  cellar,  loft,  and  every  lonely 
room  and  place  were  peopled  by  her  with  ghostly  shapes 
and  ghastly  figures, — with  demons,  devils,  sprites,  and 
gnomes.  In  her  sleep  she  did  not  fare  any  better,  since 
she  saflFered  from  frightful  dreams  and  nightmares. 
The  patient  thus  passed  her  childhood  in  continuous 


Psychognosis  of  the  Psychopathic  Substratum     257 

fear  of  unknown  and  mysterious  powers,  surrounding 
her  on  all  sides.  The  child  lived  in  constant  terror  of 
things  she  could  not  give  an  account  of;  she  was  afraid 
and  did  not  know  of  what.  It  was  really  a  cultivated 
form  of  panophobia  developed  in  a  sensitive  child. 
Later  on  the  fears  apparently  lapsed,  but  really  did  not 
disappear, — the  fears  became  subconscious.  It  was 
those  dissociated,  subconscious  fears  of  something  indefi- 
nite and  intangible  of  early  childhood  that  were 
manifested  in  the  stress  and  worries  of  fully  developed 
womanhood  as  an  inexpressible,  unaccountable  fear  of 
some  impending  evil;  in  short,  as  panophobia. 

Mrs.  A.  is  twenty-two  years  old;  Russian;  married. 
She  suffers  periodically  from  attacks  of  violent  head- 
aches, lasting  several  days.  Family  history  is  good, 
parents  are  alive,  and  never  suffered  from  any  physical 
or  mental  diseases.  Mrs.  A.  is  easily  frightened,  and 
has  suffered  from  headaches  and  pressure  on  head  for 
quite  a  long  time,  but  the  pain  became  exacerbated 
some  five  years  ago.  The  attack  is  sudden,  without 
any  premonitory  feelings,  and  lasts  from  eight  hours 
to  two  days.  The  headache  often  sets  in  at  night, 
when  she  is  asleep,  and  she  wakes  up  with  frightful  pain. 
At  the  time  of  the  first  attack  she  was  very  much  run 
down.  Otherwise  the  patient  is  in  good  condition,  but 
complains  that  her  memory  is  getting  bad.  Patellar 
reflex  is  exaggerated.  Field  of  vision  is  normal.  The 
eyes  show  slight  strabismus  and  astigmatism,  corrected 
by  glasses,  which  did  not  in  the  least  diminish  the  inten- 
sity as  well  as  the  frequency  of  the  headaches. 

Mrs.  A.  suffers  from  bad  dreams  and  distressing 
nightmares,  the  content  of  which  she  cannot  recall  in 
her  waking  state.  She  also  often  has  hallucinations, 
visions  of  two  women  wrapped  in  white,  pointing  their 
fingers  at  her  and  running  after  her.  She  never  had 
any  fall,  nor  any  special  worry  or  anxiety,  never  suffered 


258     Causation  and  Treatment,  Psychopathic  Diseases 

from  any  infectious  diseases.  After  a  persistent  in- 
quiry, however,  she  gave  an  account  of  an  accident 
she  met  with  when  a  child  of  eight.  Opposite  her 
house  there  lived  an  insane  woman  of  whom  she  was 
mortally  afraid.  Once  when  the  parents  happened  to 
be  away,  the  insane  woman  entered  the  house  and 
caught  the  child  in  her  arms  ami  greatly  frightened  her. 
Another  time  she  was  sent  out  by  her  parents  to  buy 
something  in  a  grocery  store.  It  was  night  and  very 
dark.  She  bought  the  things  and  on  the  way  back 
she  saw  two  women  in  white  with  hands  stretched  out 
running  after  her.  She  screamed  from  great  fright  and 
ran  home. 

Mrs.  A.  is  very  much  afraid  to  remain  alone,  and 
especially  in  the  dark.  She  is  not  so  much  afraid  in 
the  street  as  in  the  house.  The  two  women  appear  to 
her  now  and  then,  and  she  is  mortally  afraid  of  them. 

The  patient  was  put  into  hypnotic  state.  There 
was  marked  catalepsy;  the  eyes  were  firmly  closed,  and 
she  could  not  open  them  when  challenged.  Suggestion 
of  general  well-being  was  given  and  she  was  awakened. 
On  awakening,  she  could  not  remember  what  had  taken 
place  in  the  hypnotic  state. 

Next  day  she  was  again  put  into  hypnosis  and  went 
into  a  deeper  state  than  the  day  before.  She  was 
asked  whether  she  thought  of  the  crazy  woman  occa- 
sionally, she  replied  in  the  negative.  The  patient  spoke 
in  a  low,  suppressed  voice,  the  words  coming  out 
slowly,  as  if  with  effort  and  with  fear.  It  was  then 
insisted  that  she  should  tell  one  of  her  recent  dreams. 
After  some  pause,  she  said:  "Last  night  I  had  a  bad 
dream;  I  dreamed  that  I  stood  near  a  window  and  a 
cat  came  up  to  the  same  window.  I  saw  it  was  crazy. 
I  ran  away  and  the  cat  ran  after  me  and  bit  me  and 
scratched  me.  Then  I  knew  that  I  was  crazy.  My 
friends  said  that  there  was  no  help  for  me.     I  dropped 


Psychognosis  oj  the  Psychopathic  Substratum     259 

the  baby,  ran,  and  jumped  down  stairs.  I  remember 
now  that  when  I  fell  asleep  I  saw  a  woman,  maybe  the 
crazy  woman.  I  covered  myself;  I  knew  I  was  only 
afraid,  and  that  she  was  not  real.  Six  weeks  ago  I  saw 
the  same  woman,  when  falling  asleep  or  when  asleep. 
I  ran  away  and  she  ran  after  me  and  wanted  to  catch 
me."  Mrs.  A.  in  relating  these  dreams,  shivered  all 
over  and  was  afraid,  as  if  actually  living  the  dream- 
experience  over  again.  "It  was  this  woman  who 
caught  me  in  her  arms  and  kissed  me,  and  embraced 
me  and  did  not  let  me  go,  until  my  screams  brought 
friends  and  my  father,  and  they  took  me  away  from 
her  by  force. " 

Gradually  some  more  dreams  emerged.  "I  dreamed 
some  time  ago  that  the  woman  came  to  me  and  spilled 
hot  water  on  me.  Another  time  I  dreamed  that  I  was 
in  the  insane  asylum;  she  came  out,  told  me  she  was 
well;  I  was  greatly  frightened  and  ran  away."  Mrs. 
A,  then  became  quiet.  After  awhile  she  began  to 
relate  a  series  of  dreams.  Sometime  ago  she  dreamed 
that  the  woman  entered  the  room  where  her  father  was 
and  ran  up  to  him,  evidently  with  the  intention  of 
hurting  him.  Her  father  ran  away,  and  she  hid  herself 
in  a  closet  in  the  next  room.  "  I  also  dreamed  that  the 
woman  was  shadowing  me  in  an  alley.  She  wanted  to 
get  hold  of  me,  while  I  was  trying  to  get  away  from  her. 
I  turned  round,  and  she  gave  me  such  a  fierce  look. 
It  was  so  fierce.  I  ran  and  she  could  not  catch  me. 
I  should  die,  if  she  catches  me."  Mrs.  A.  shivered, 
"Are  you  afraid  of  her.?"  "Not  now,  she  is  not  here. 
I  did  not  dream  of  the  woman  much  before,  but  some- 
time before  my  marriage  I  began  to  dream  of  her  quite 
often.  In  one  of  my  dreams  about  her  I  saw  people 
putting  cold  water  on  her,  and  I  could  hear  her  scream. 
It  was  awful!  I  dreamed  I  went  upstairs,  opened  the 
door  and  met  her  face  to  face.     I  was  badly  frightened, 


26o     Causation  and  Treatment,  Psychopathic  Diseases 

but  could  not  run  away,  so  I  jumped  out  of  the  window. 
If  I  could  only  not  dream  about  her. " 

This  is  an  extract  from  a  letter  sent  to  me  by  the 
patient's  husband:  "...  She  had  another  at- 
tack, it  did  not  last  long,  and  it  was  not  severe.  She 
dreamt  several  times  this  week.  I  shall  try  to  relate 
them  as  accurately  as  possible.  She  dreamt  that  I 
left  the  room  for  a  while.  Our  baby  was  sleeping  in 
the  next  room.  All  of  a  sudden  she  heard  baby  cry 
out:  'Mamma  I  am  afraid!'  She  told  the  baby  to 
come  to  her  as  she  herself  was  afraid  to  leave  the  bed. 
Baby  came  to  her.  The  child  looked  frightened,  her 
face  pale  with  fear,  exclaiming  'Mamma,  a  devil!' 
As  the  child  cried  out,  my  wife  heard  a  noise  in  the 
room,  something  moved  close  by.  She  became  very 
much  frightened.  It  seemed  to  her  that  something 
terrible  and  unknown  was  after  her.  She  wanted  to 
scream  for  help,  but  could  not.  A  hand  was  stretched 
out  after  her  to  catch  her.  She  woke  up  in  great  terror. 
Another  time  she  dreamt  that  she  was  in  a  hall  way, 
she  saw  a  woman  and  became  frightened.  It  was  the 
same  crazy  woman.  My  wife  is  exceedingly  nervous 
and  in  fear  that  something  awful  is  going  to  happen 
to  her  or  to  the  family.     .     .     . " 

A  rich,  subconscious  dream-life  of  agonizing  fears 
was  thus  revealed,  a  life  of  fears  of  which  the  patient 
was  unaware  in  her  waking  state.  The  dreams  referred 
to  the  same  central  nucleus,  the  shock  and  fears  of  her 
early  childhood.  Worries  about  self  and  family  kept 
up  and  intensified  the  present  fear  states.  The  symp- 
tom complex,  as  in  all  other  psychopathic  cases,  took 
its  origin  in  the  impulse  of  self-preservation  with  Its 
accompanying  fundamental  fear  instinct. 

C.  Age  sixty-one.  Italian.  Family  history  is  good. 
Has  two  children.  Patient's  trouble  dates  back  forty 
years.     It  is  intermittent  in  character,  appearing  every 


Psychognosis  of  the  Psychopathic  Substratum     261 

year  or  every  two  years  and  lasting  for  a  period  of  two 
weeks.  The  length  of  the  attacks  has  gradually  in- 
creased. The  attack  he  is  suffering  from  at  present 
(1903,  July  17)  lasted  for  about  a  year  and  a  half,  and 
incapacitated  him  from  carrying  on  his  occupation  as 
hair-dresser. 

When  the  patient  came  to  this  country,  he  worked 
in  a  barber  shop.  He  strongly  objected  to  the  occupa- 
tion and  had  an  intense  dislike  to  the  place  he  worked 
in  so  that  even  now  he  describes  it  with  a  shiver  and 
speaks  of  it  in  terms  of  disgust  as  "dark,  gloomy,  and 
horrid. "  Patient  used  to  suffer  then  from  attacks  of 
depression  which  would  last  for  several  weeks.  He 
conceived  a  hatred,  a  sort  of  terror  of  the  razor  which 
was  constantly  before  his  eyes.  He  could  not  assure 
himself  that  the  razor  was  in  proper  condition,  or 
that  it  was  really  well  cleaned,  and  he  would  keep  on 
wiping  it  incessantly.  From  this  "barber  period"  date 
all  sorts  of  insistent  ideas;  all  kinds  of  forms  of  uncon- 
trollable impulses  gradually  began  to  take  possession 
of  the  patient's  mind.  The  patient  specially  suffered 
from  those  recurrent  mental  states  during  the  attacks 
of  depression.  We  can  give  here  but  a  few  examples 
of  them  as  their  number  and  full  description  would 
require,  as  a  the  patient  put  it,  "big  volumes." 

In  one  of  his  attacks  he  conceived  an  incense  dread 
of  "hands  in  his  pocket."  By  accident  his  wife 
chanced  to  put  a  handkerchief  into  the  patient's 
overcoat  pocket;  the  patient  was  forced  to  give  the  new 
overcoat  away  and  have  a  special  overcoat  made  "with- 
out pockets."  Once  he  took  a  walk  with  his  children 
and  a  stone  on  the  way  "troubled"  him.  "It  was  not 
in  the  right  place.  I  cheated  my  children  as  I  did  not 
want  them  to  suspect  my  trouble.  I  sent  them  ahead 
on  some  pretext  and  remained  behind,  removed  the 
stone,  and  then  was  satisfied. "     On  another  occasion  a 


262     Causation  and   Treatment,  Psychopathic  Diseases 

carpenter  fixed  the  steps  in  his  shop.  Patient  noticed 
two  nails  which  made  him  feel  uneasy,  and  finally 
tantalized  him.  He  called  the  carpenter  again  and  on 
the  pretext  that  there  were  some  dead  rats,  he  had  him 
remove  the  nails  and  the  plank.  He  did  not  permit 
the  planks  with  the  nails  to  be  replaced.  On  another 
occasion  a  hole  under  the  sink  was  plugged  up  with 
paper  and  then  cemented.  The  patient  became  rest- 
less and  full  of  anxiety  until  he  opened  the  hole  again 
and  with  great  difficulty  took  the  obnoxious  paper  out. 
When  the  house  was  repaired  the  plumber  would  plug 
up  the  hole  in  a  similar  fashion  and  he  watched  him 
the  whole  day,  standing  close  to  the  plumber,  fearing 
the  plumber  might  plug  up  the  hole  with  paper.  Dur- 
ing this  watch  the  patient  was  in  a  state  of  fear,  and 
when  the  work  was  over  he  was  exhausted  from  his 
anxious  vigil. 

Two  years  ago  patient  was  more  or  less  free  from 
these  insistent  ideas  and  impulses,  but  the  landlord 
took  it  in  his  head  to  make  some  alterations  in  the 
house,  and  since  that  time  patient  became  worse,  the 
ideas  and  impulses  torture  him  constantly.  "Oh  my 
God,  that  landlord  made  those  changes!"  When  the 
ideas  and  impulses  are  not  carried  out  the  patient  be- 
comes restless,  feeling  of  anxiety  grows  into  intolerable 
fear.  A  terror  of  some  unknown  evil  possesses  him. 
There  is  an  increased  pressure  on  the  head  and  he  is 
in  agony  until  the  impulse  is  carried  out,  then  with  a 
sigh  of  relief  he  says:  "Now  I  am  satisfied.  Have  you 
ever  seen  anything  like  It.?" 

The  patient  has  a  general  unaccountable  fear,  pano- 
phobia,  gets  easily  frightened — he  Is  fear  obsessed — 
nails,  strings,  bits  of  paper,  pins,  stones  on  the  road  and 
other  things  perturb  his  mind  greatly,  and  must  be 
removed  before  he  can  be  at  rest. 

The  patient  must  do  things  over  and  over  again  before 


Psychognosis  of  the  Psychopathic  Substratum     263 

he  can  assure  himself  that  the  things  are  all  right. 
Folie  du  doute  is  quite  pronounced  in  him.  He  must 
rise  from  bed  some  fifteen  times  and  more  to  assure 
himself  that  the  door  is  locked,  or  that  the  gas  is  turned 
down.  The  emotion  of  fear  with  the  feeling  of  insecuri- 
ty and  anxiety  seems  to  be  always  present  and  associated 
with  his  active  life.  He  is  never  sure  that  things,  how- 
ever trivial,  are  done  the  right  way. 

The  patient  has  a  special  dread  of  giving  his  ad- 
dress or  giving  his  name,  and  he  is  terrorized  when 
he  is  asked  to  write  his  name.  When  he  is  forced 
to  give  it,  on  account  of  business,  or  to  his  friends, 
he  suffers  agony  the  whole  day.  While  taking  the 
history,  the  patient  was  asked  his  name.  He  start- 
ed as  one  shot.  "Oh,  my  God!  Do  not  ask  me!" 
He  took  out  an  envelope  from  his  pocket,  and  told  me 
to  copy  his  name.  He  watched  closely,  looking  the 
paper  over  and  over  again  to  assure  himself  that  the 
name  was  correctly  copied.  When  asked  for  his  ad- 
dress he  was  scared,  ran  out  into  the  hall;  the  wife  had 
to  give  the  address. 

The  patient  is  easily  thrown  into  a  state  of  fear  and 
terror;  he  is  restless;  he  would  every  time  rise  from 
his  chair  and  exclaim:  "Oh,  my  God!  Think  what  I 
have  to  suffer!"  He  says  he  cannot  describe  all  his 
experiences.  He  wishes  that  some  one  who  is  a  good 
writer  should  have  his  experience  for  at  least  thirty 
days,  and  then  describe  it  all.  The  patient  had  no 
cuff-buttons  on,  he  was  afraid  he  would  lose  them; 
he  did  not  want  to  go  to  the  box  in  which  the  buttons 
were,  and  he  could  not  let  anyone  else  take  them. 

The  patient  does  not  complain  of  any  other  trouble; 
appetite  is  good,  though  his  sleep  is  disturbed;  has 
lost  somewhat  in  weight  recently.  He  is  a  tall,  well 
developed  man,  he  is  somewhat  pale  and  has  a  care- 
worn expression  on  the  face;  his  mind  is  clear.     He 


264     Causation  and   Treatment,  Psychopathic  Diseases 

fully  realizes  the  absurdity  of  his  insistent  ideas  and 
impulses  and  laughs  at  them,  calls  them  "foolish,  ridicu- 
lous." Physical  examination  is  negative.  Knee  jerks 
exaggerated.  No  clonus.  Pupils  react  to  light  and 
accommodation.     Field  of  vision  normal. 

While  patient  was  being  examined  he  happened 
to  catch  sight  of  a  piece  of  string  on  the  gas-jet,  he 
started,  became  agitated  and  exclaimed:  "Oh,  my  God! 
There  is  a  string!  I  won't  look  at  it,"  and  he  turned 
his  head  away,  but  it  was  of  no  avail.  The  string 
seemed  to  have  had  an  irresistible  attraction,  he 
looked  at  it  and  watched  it  from  the  corner  of  his  eye. 
Finally,  he  could  not  stand  it  and  began  to  beg  for 
permission  to  cut  the  string.  When  the  string  was 
cut  he  felt  relieved.  "It  is  all  right  now,"  he  said,  and 
added,  "isn't  it  fooHsh.?" 

Patient  asked  me  if  there  was  any  danger  of  his  wife 
catching  his  disease;  he  was  assured  that  there  was  no 
danger,  and  he  felt  satisfied.  A  few  minutes  later  he 
wanted  to  be  reassured  that  there  was  no  danger. 

Patient  saw  me  write  his  name,  he  examined  the 
writing  minutely  to  make  sure  that  every  thing  was 
all  right.  He  did  not  feel  satisfied  however.  "Have 
you  made  the  dot  on  the  'i'.^"  "Are  you  sure?  Lett 
me  see  it  again,  please.  Make  the  dots  over  again." 
The  dots  had  to  be  emphasized  and  made  quite  big  so 
as  to  satisfy  him.  "Now  it  is  good,  all  right."  He 
was  asked  to  write  his  name;  he  refused  to  do  it,  and 
finally  after  long  persuasion  he  agreed  to  write  on  his 
own  paper.  He  was  very  particular  about  the  dots 
and  as  soon  as  he  finished  writing,  he  put  the  paper 
immediately  into  his  pocket.  When  asked  to  write 
his  name  on  the  paper  given  to  him  he  positively 
refused.  Said,  "  I  will  not  be  able  to  go  home  and  will 
have  no  rest.     I  may  do  it  next  time. " 

Patient  was  then  asked  to  write  24,  42,  and  make 


Psychognosis  of  the  Psychopathic  Substratum     265 

an  addition.  He  at  first  hesitated,  but  finally  wrote, 
though  with  an  air  of  extreme  unwillingness.  He  first 
took  out  a  slip  of  paper  from  his  own  pocket  and 
wanted  to  write  on  it,  but  it  was  insisted  that  he 
should  write  on  our  paper.  The  numbers  were  written 
down  and  the  addition  correctly  performed.  No  soon- 
er was  the  operation  completed  then  he  exclaimed: 
"No,  let  me  write  it  over,  it  is  not  well."  He  tore 
off  the  paper  on  which  it  was  written  and  put  it  in 
his  pocket.  He  wrote  the  numbers  again  and  looked 
at  them  hesitatingly.  "I  think  those  numbers  ought 
to  be  a  little  further  apart. "  He  was  assured  that  it 
was  all  right,  and  the  paper  was  taken  away  from  him. 
His  attention  was  distracted  by  some  electricity  which 
was  given  to  him.  Immediately  after  the  treatment 
he  began  to  plead  that  the  paper  on  which  the  num- 
bers were  written  be  returned  to  him.  His  fear  was 
intense."  Oh,  my  God,  I  must  have  the  paper.  I  will 
have  no  rest  without  it."  He  grasped  my  hand  and 
began  to  kiss  it,  imploring  me  for  the  paper.  As  soon 
as  the  paper  was  given  to  him  he  eagerly  grasped  it. 
His  expression  was  that  of  intense  delight.  "I  am 
very  much  pleased  with  you,"  he  said," I  like  you." 

Patient  was  questioned  about  his  dreams.  Said  that 
about  fifteen  years  ago  used  to  have  many  bad  dreams, 
but  he  could  not  remember  any  of  them.  Was  asked,  if 
he  ever  had  any  dreams  about  nails  or  strings.  Patient 
grew  restless  and  uneasy  at  this  question.  He  said  that 
he  did,  but  could  not  remember  them.  While  patient 
was  talking  he  saw  a  pin  in  a  chink  of  the  floor.  He 
grew  uneasy,  took  out  a  knife,  and  with  some  efforts 
succeeded  in  getting  at  the  object  which  turned  out  to 
be  a  piece  of  wood.  The  patient  realized  fully  the  ab- 
surdity of  his  action.  "  Is  it  not  foolish  ? "  he  said.  "  I 
call  that  ridiculous."     Patient  says  that  if  he  were  rich 


266     Causation  and   Treatment,  Psychopathic  Diseases 

would  have  a  house  built  in  which  no  nails  could  be 
seen,  or  better  still,  without  any  nails. 

Patient  was  put  in  hypnosis.  After  a  few  minutes  of 
fixation,  his  eyes  closed.  Condition  was  that  of  com- 
plete relaxation.  Eyes  were  firmly  closed.  When  chal- 
lenged to  open  them  he  could  not  do  so.  Catalepsy  was 
readily  induced.  While  in  hypnosis  he  was  questioned 
about  his  dreams.  The  result  was  striking.  While  in 
his  waking  state  he  could  not  recall  a  single  dream,  in 
the  hypnotic  condition  the  dreams  came  to  the  surface 
with  great  ease.  He  related  one  dream  after  another. 
Dreams  of  fifteen  or  twenty  years  ago  came  up  appar- 
ently without  any  effort  The  dreams  were  about  peo- 
ple who  wanted  to  kill  him  with  revolvers  or  clubs  At 
other  times  again  he  dreamt  that  he  was  falling  from 
high  places.  It  was  insisted  that  he  should  rem'nd 
himself  of  any  frights  or  accidents  that  he  ever  had. 
It  was  found  that  when  fifteen  years  old  while  walking 
through  the  streets  of  his  native  town  he  saw  from  a 
distance  a  large  stone  and  thought  it  was  a  coffin;  it 
was  during  the  time  of  the  cholera,  this  frightened  him 
greatly.  Another  fright  he  had  was  twenty  years  ago. 
He  was  going  on  a  train  to  Rockaway.  The  train 
ahead  of  him  got  wrecked,  and  he  saw  many  bodies, 
dead  and  wounded.  This  affected  him  greatly, — the 
fear  psychosis  became  fixed  and  predominant  in  his  emo- 
tional life. 

The  psychopathology  of  the  case  is  a  diseased  impulse 
of  self-preservation  and  a  morbid  state  of  the  fear  in- 
stinct. 

Mrs.  C.  C,  thirty-five  years  old;  married  three  years. 
Father  is  of  neurotic,  passionate  temperament;  mother 
is  nervous,  seems  to  suffer  from  some  kind  of  epilepti- 
form attacks,  and  periodically  from  severe  hemicrania. 
Brother  and  sister  are  well,  though  also  nervous  and 
excitable. 


Psychognosis  of  the  Psychopathic  Substratum     267 

Patient  Is  quite  intelligent,  but  very  emotional, — 
cries  at  the  least  provocation;  her  attention  is  easily 
distracted;  mental  processes  are  normal.  Desultory 
memory  for  numbers  and  syllables  is  poor,  but  logical 
memory  for  events  past  and  present  Is  well  preserved. 
There  are  no  perceptual  disturbances, — no  illusions,  no 
hallucinations.  Sleep  is  light,  and  is  disturbed  by 
dreams. 

Physical  examination  Is  negative;  except  for  the  fact 
of  marked  Ill-nutrition  and  flabbiness  of  muscles,  noth- 
ing special  could  be  observed.  Patellar  reflex  Is  exag- 
gerated. Pupillary  reaction  and  accommodation  to 
light  and  distance  are  normal.  Field  of  vision  Is  normal. 
No  motor  disturbances.  She  complains  of  creeping 
sensations  in  the  extremities,  In  the  hands  and  legs,  also 
of  tingling  sensations  and  numbness  in  the  body  and 
of  pains  in  the  back.  An  examination,  however,  shows 
that  the  patient's  sensitivity  to  all  forms  of  stimula- 
tions is  normal.  At  times  she  suffers  much  from  pains 
In  the  back,  from  paraesthesia,  tingling  sensations, 
and  numbness  of  the  extremities  and  from  paresis  of 
the  whole  body.  Motor  imitation  is  marked,  the 
patient  frequently  copies  and  Imitates  motor  habits 
that  specially  impress  her.  During  the  course  of  her 
life  patient  has  taken  up  all  kinds  of  motor  habits  and 
twitchings,  although  she  succeeds  in  arresting  them. 
The  motor  automatisms  are  not  of  an  Insistent  char- 
acter. 

What  the  patient,  however,  specially  complains  of  is 
Insistent  ideas  and  feelings  which  torture  her,  and  from 
which  she  is  unable  to  free  herself.  Thus,  she  has  an 
extreme  abhorrence  of  women.  Woman  to  the  patient 
is  impurity,  filth;  woman  to  her  is  the  very  incarnation 
of  degradation  and  vice.  She  would  not  pass  a  woman, 
if  she  could  help  it.  Patient  tells  me  she  would  not 
have  come  up  to  my  office  had  a  woman  been  standing 


268     Causation  and  Treatment^  Psychopathic  Diseases 

on  the  steps.  She  cannot  pass  a  woman  without  a 
sense  of  nauseating  disgust.  The  house-wash  must  not 
be  given  to  a  laundry  where  women  work. 

The  patient's  husband  corroborated  the  general 
symptoms  and  gave  additional  data.  They  had  to 
break  up  house  and  remove  to  another  one,  because 
carriages  opposite  their  window  happened  to  be  hitched 
in  knots  and  in  angles  which  the  patient  could  not 
tolerate.  Pencils,  sticks,  books  and  other  objects  must 
be  put  parallel  to  the  wall  and  not  so  as  to  form  an 
angle  or  be  brought  In  relation  with  any  of  the  angles 
of  the  room.  In  kissing  her,  the  husband  must  be 
careful  that  the  kisses  should  not  be  in  a  vertical  posi- 
tion, nor  form  any  angles,  but  all  must  be  arranged  in 
rows,  parallel  to  the  wall.  When  dining  in  a  restau- 
rant, should  a  gentleman  and  a  lady  happen  to  come 
near  them,  the  table  must  be  immediately  left  in  the 
very  middle  of  the  meal. 

Patient  has  certain  formulae  and  phrases  which  she 
seems  to  regard  with  superstitious  awe,  although  she 
is  conscious  of  their  absurdity.  She  Insists  that  the 
husband  should  repeat  verbatim  the  phrases,  and  if  he 
happens  to  substitute  another  word,  or  phrases  the 
terms  differently,  she  is  much  disturbed;  he  has  to  help 
himself  out  with  a  dictionary,  she  is  not  supposed  to 
tell  him  the  words.  When  she  attempts  to  counteract 
her  insistent  ideas  and  Impulses,  she  has  crises  of  cry- 
ing and  of  intense  depression  and  suffers  agony.* 

Patient  feels  unhappy  and  is  distressed  over  the 
misery  she  is  in,  and  of  the  pain  she  causes  her 
husband.  She  bewails  her  lot,  regards  herself  as 
insane,  but  the  Ideas  and  Impulses  are  irresistible 
and  uncontrollable.  Mr.  C.  tells  me  that  his  wife 
experiences  horror  and   disgust  at  the  touch,  at  the 

*A11  these  are  evil  omens,  tests  and  charms,  formed  by  the  patient  on 
the  principle  of  metathesis,  contrast,  and  others. 


Psychognosis  of  the  Psychopathic  Substratum      269 

mere  sight  of  a  woman.  He  must  be  on  the  look 
out  not  to  be  In  one  line  with  a  woman,  even  if  the 
woman  be  two  or  three  blocks  away.  Nothing  must 
be  picked  up  on  the  street,  not  even  the  most  valu- 
able object,  perchance  it  might  have  been  dropped 
by  a  woman.  A  woman  once  happened  to  visit  his 
wife,  who  could  not  help  herself  and  had  to  admit  her 
female  guest.  The  visitor  was  sent  oflF  by  some  excuse 
or  other.  Unfortunately,  the  woman  before  leaving 
stopped  on  the  threshold  of  the  house  for  a  few  mo- 
ments. The  house  was  at  once  washed,  cleaned, 
scrubbed,  and  purified  as  after  a  pest.  The  husband 
was  not  permitted  to  enter  that  door  for  a  week,  until 
the  threshold  was  ripped  up,  another  new  one  made, 
and  the  position  of  the  door  changed.  Patient  has  un- 
accountable fears;  she  does  not  know  what  It  is  she  is 
afraid  of;  she  is  only  conscious  that,  when  she  remains 
alone,  especially  in  the  evening,  a  fear  suddenly  seizes 
her. 

The  hypnoidal  state  brought  out  the  fact  that  the 
patient,  who  was  educated  in  a  convent,  was  easily 
frightened  and  was  specially  afraid  of  the  dead  and  of 
the  devil.  While  in  convent  she  used  to  have  frightful 
dreams  In  which  the  devil  played  the  chief  part.  Thus 
once  she  dreamed  that  the  devil  pinched  her  ear;  she 
cried  out  and  woke  up  In  great  fear.  The  nun  up- 
braided her,  because  the  devil  could  not  possibly  visit 
such  a  holy  institution  as  a  convent.  Once  the  devil 
threw  her  out  of  bed  and  threw  the  mattress  after  her. 
The  people  in  the  convent  became  frightened,  and 
the  girls  screamed  and  prayed.  The  priest  was  called 
for,  and  he  asked  the  patient  whether  she  had  been 
praying  for  the  lost  souls  in  purgatory.  On  being  an- 
swered In  the  affirmative  the  priest  advised  her  not  to 
pray  any  longer,  because  the  souls  from  purgatory 
troubled  her.     She  stopped  praying  for  the  lost  souls 


270     Causation  and   Treatment,  Psychopathic  Disease^ 

and  the  trouble  completely  disappeared.  It  is  the  fear 
of  evil  agencies  that  keeps  on  persisting  in  the  subcon- 
scious life  of  our  patient  and  is  now  and  then  giving  rise 
to  indefinite  fears  of  the  unknown,  panophobia.  The 
foundation  of  this  panophobia  was  laid  in  the  patient's 
tender  childhood,  and,  although  she  no  longer  believed 
in  evil,  impure  agencies,  in  fact  even  ridiculed  them, 
still  the  fear  did  not  fully  lapse, — it  became  dissociated 
and  subconscious. 

The  patient's  motor  automatisms  and  imitativeness 
can  be  readily  traced  to  her  childhood.  As  a  young 
child  patient  was  very  impressible,  highly  suggestible, 
more  so  than  any  other  child  of  her  age  — she  suffered 
then  from  habit-tics  and  from  choreic-like  movements 
and  twitchings.  The  suggestibility  of  the  patient's 
waking  state  is  now  greatly  reduced,  but  the  subcon- 
scious suggestibility  Is  as  strong  as  ever.  She  can, 
however,  easily  free  herself  from  such  subconscious 
motor  suggestions  and  imitations,  so  that  they  do  not 
trouble  her  much.  They  are  but  transient  and  soon 
tend  to  disappear. 

''^Some  twelve  years  ago  the  patient  had  a  bad  fall 
and  hurt  her  spine.  It  is  to  that  fall  that  the  subjective 
paraesthesia  in  the  extremities,  the  tingling  sensations — 
numbness,  paresis  and  pains  in  the  back  can  be  traced, — 
the  patient  passes  at  each  attack  through  the  original 
experiences  of  the  accident  of  the  fall. 

When  about  the  age  of  eighteen  the  patient  suffered 
a  great  shock, — one  of  her  near  relatives  attempted  to 
assault  her  at  night.  This  accident  threw  her  into  a 
series  of  attacks  which  she  characterized  as  "hysterical 
attacks."  She  really  never  got  fully  over  it,  and  the 
incident,  though  apparently  but  faintly  present  in  her 
conscious  memory,  has  remained  active  In  her  sub- 
conscious life. 

The  patient's  gynophobia  or  hatred  of  women   may 


Psychognosis  of  the  Psychopathic  Substratum     271 

be  traced  to  her  training  received  in  the  convent. 
While  there  she  was  impressed  with  the  behef  that 
woman  is  a  vessel  of  vice  and  impurity.  This  seemed 
to  have  been  impressed  on  her  by  one  of  the  nuns 
who  was  holy  and  practiced  self-mortification.  With 
the  onset  of  her  periods,  and  with  the  observation  of 
the  same  in  the  other  girls,  this  doctrine  of  female 
impurity  was  all  the  stronger  impressed  on  her  sensitive 
mind.  This,  however,  lapsed  from  her  conscious  mem- 
ory and  did  not  come  to  the  foreground  of  consciousness 
until  later  in  life  when  she  was  fatigued  and  exhausted 
by  the  strain  of  office  work,  toiling  many  days  at  a 
stretch.  Still  this  dissociated,  subconsciously  buried 
prejudice  of  youth  might  have  never  come  to  the  sur- 
face had  not  another  factor  favored  its  forthcoming  and 
resurrected  an  experience  that  had  apparently  long 
gone  from  her  active  life.  Three  years  ago  the  patient 
married  a  man  somewhat  younger  than  herself.  Being 
of  a  highly  sensitive  mind  and  of  a  suspicious  dis- 
position, she  developed  an  intense  feeling  of  jealousy 
in  regard  to  her  husband.  It  was  under  these  condi- 
tions of  jealousy  that  the  long-buried  and  dissociated 
belief  in  the  im^purity  of  woman  came  to  life  again. 

Instead  of  applying  it  to  herself,  the  feeling  of  gyno- 
phobia was  applied  to  others.  This  is  due  to  the  jeal- 
ousy which  called  forth  that  subconscious  atavistic 
belief  of  the  patient's  religious  youth.  The  magic  for- 
mulae and  superstitions  full  of  fear  belong  to  the  same 
subconscious  stratum. 

Patient  is  a  woman  of  forty-four,  married  at  the  age 
of  twenty-four;  nineteen  years  ago  had  salpingitis  and 
pelvic  cellulitis,  for  which  she  had  all  forms  of  treat- 
ments and  operations.  All  these  treatments  did  not 
alter  her  condition.  She  finally  fell  into  the  hands  of  a 
gynecologist  who,  after  treating  her  by  all  kinds  of 
gynecological  methods,  became  tired  of  her,  and  referred 


272     Causation  and   Treatment,  Psychopathic  Diseases 

her  to  a  neurologist  who  tried  his  neurological  powers 
and  gave  her  up  in  his  turn.  By  this  time  the  patient 
was  frantic  with  the  fixed  idea  of  operations.  She  was 
in  terror  of  her  trouble,  and  she  raged  at  her  invalidism. 
The  patient  became  obsessed  with  faith  in  surgical 
operations  as  a  cure  of  her  terrible  state  from  which 
she  must  be  delivered  at  any  cost.  One  operation  after 
another  was  performed  on  her  for  the  relief  of  her 
"fearful  suffering."  She  had  an  operation  of  ventral 
suspension,  another  operation  for  pelvic  adhesions, 
another  for  rectal  stricture,  and  a  number  of  other  ones 
just  in  order  to  humor  her. 

Under  osteopathic  treatment  she  developed  the  fixed 
idea  that  she  had  a  Lane's  kink.  Recent  skiagrams, 
of  which  I  received  a  great  number,  developed  in  her 
the  fear  of  some  trouble  in  her  "sigmoid  flexure." 
This  "sigmoid  flexure"  keeps  on  moving  up  and  down 
in  the  body,  keeps  on  pounding  until  it  makes  her  feel 
nauseated,  sick,  in  constant  agony  of  headache,  full  of 
pains  in  the  left  side,  unable  to  walk,  even  to  make 
a  step,  unable  to  see  or  to  read,  unable  to  do  any 
work,  on  account  of  the  constant  agonies;  incapable  of 
eating,  incapable  of  thinking,  and  generally  being  in  a 
state  of  "living  death." 

The  patient  was  in  terror  of  her  "sigmoid  flexure" 
which  actually  incapacitated  her  from  doing  anything. 
She  was,  to  all  intents  and  purposes,  paralyzed  by 
the  fear  of  "sigmoid  flexure"  of  which  she  kept  on 
thinking  day  and  night,  and  of  which  she  was  in  a  pan- 
ic, lest  it  became  paralyzed,  "relaxed,  dead,"  and  then 
begin  to  pound.  The  pounding  and  the  paralysis  of 
the  sigmoid  flexure  were  to  her  the  Scylla  and  Charyb- 
dis  between  which  she  had  to  steer  in  order  to  avoid 
"the  horrors  of  her  sufferings." 

For  some  time  she  was  in  fear  of  taking  any  food, 
because  this  excited  the  sigmoid  flexure  to  activity  and 


Psychognosis  of  the  Psychopathic  Substratum     273 

pounding  with  consequent  paralysis  of  the  lower  in- 
testinal tract.  In  such  a  state  she  was  frantic  with 
fear.  She  ran  around  and  asked  for  the  thumping  to 
begin;  sometimes  when  the  thumping  was  too  much 
for  her,  she  asked  to  be  taken  out  in  an  automobile,  in 
order  to  paralyze  and  "deaden"  the  overactive  sigmoid 
flexure.  She  fell  back  on  liquid  food  and  that  only  in 
spare  quantities,  took  to  her  bed,  did  not  want  to  see 
anybody,  did  not  walk  on  account  of  her  "extreme 
feebleness,"  could  not  do  anything,  and  became  emaci- 
ated and  an  invalid  for  years. 

The  fear  of  indigestion  and  the  sigmoid  horror 
poisoned  her  life  and  extended  to  all  her  activities 
finally  reducing  her  to  a  living  skeleton,  to  "a  machine, 
to  an  automaton. "  She  was  afraid  to  walk  a  few  yards 
for  fear  of  the  sigmoid  flexure.  The  "sigmoid  flexure 
system"  extended  and  finally  invaded  the  whole  of  her 
life;  she  became  nothing  but  a  sigmoid  flexure. 

The  patient  had  intervals  when  the  condition  some- 
what improved  or  rather  when  it  was  not  so  intense. 
About  every  two  weeks,  at  rather  irregular  periods, 
she  had  attacks  or  "spells,"  when  the  fear  of  the  sig- 
moid flexure  and  "the  deadening  of  her  life"  reached 
a  climax,  and  she  was  in  a  state  of  panic.  In  her  effort 
to  escape  from  the  "terror  and  horror"  of  the  sigmoid 
flexure,  the  patient  was  ready  to  do  anything.  She 
behaved  like  a  hunted  animal  frantic  with  fear. 

The  patient's  whole  mind  was  set  on  herself,  on  getting 
well,  on  her  health.  One  could  clearly  study  in  her 
the  underlying  factors  of  the  impulse  of  self-preserva- 
tion with  its  fear  instinct  as  well  as  the  factor  of  the 
low  fund  of  neuron  energy  by  the  constant  complaints  of 
exhaustion  and  fatigue  at  the  least  effort,  mental  or 
physical.  Anything  that  in  any  way  disturbed  her 
brought  about  all  the  symptoms  of  the  disease,  the 
headache,  the  nausea,  the  constipation,  the  eye-ache, 


274     Causation  and  Treatment,  Psychopathic  Diseases 

and  above  all  the  thumping  and  pounding  of  the  "sig- 
moid flexure"  with  the  consequent  paralysis  of  the  low- 
er tract  and  the  evil  effect  of  "deadness,"  accompanied 
by  a  state  of  intense  terror,  almost  uncontrollable, 
wild  fear. 

Everything  was  sacrificed  on  the  altar  of  that  merci- 
less, psychopathic  Moloch,  the  self-impulse  and  fear. 

The  following  account  is  given  by  the  patient: 

"My  earliest  recollection  of  any  illness  was  a  good 
deal  of  sore  throat,  not  excessively  severe,  not  enough 
to  keep  me  much  from  school.  When  about  seven  I 
had  a  long,  severe  attack  of  typhoid  fever  accompanied 
by  erysipelas  from  my  knees  down.  It  was  only  on 
account  of  the  greatest  care  that  I  survived. 

"During  my  childhood  I  acquired  most  of  the  chil- 
dren's diseases:  scarlet  fever,  measles,  chicken  pox,  etc. 
I  usually  spent  a  good  portion  of  the  winter  months 
indoors  with  childish  trouble.  There  was  one  thing 
that  never  failed  to  accompany  my  illnesses.  That 
was  aching  ankles.  It  exceeded  any  other  suffering  I 
had.  I  was  troubled  with  them  for  two  years;  Mr.  F. 
says  even  after  we  were  married. 

"When  I  was  between  ten  and  eleven  years  I  con- 
tracted a  fever  which  was  called  malaria,  only  I  think 
it  must  have  been  something  more  serious.  It  began 
with  a  severe  chill  and  after  that  I  was  ill  in  bed  for  a 
long  time.  When  I  was  better  my  mother  and  I  went 
abroad,  and  in  eight  months  I  gained  about  twenty- 
five  pounds,  weighing,  at  the  age  of  twelve,  ninety 
pounds. 

'^•^" After  my  return  from  Europe  I  steadily  increased 
in  weight  and  would  say  that  during  my  girlhood  days 
I  weighed  from  one  hundred  and  fifteen  to  one  hundred 
and 'twenty-five  pounds. 

"I  matured  at  thirteen  years,  six  months,  and  was 
always  normal.     During  my  periods  I  lived  my  every- 


Psychognosis  of  the  Psychopathic  Substratum     275 

day  life,  going  to  school,  dancing,  and  doing  anything 
that  I  did  at  other  times. 

"At  about  thirteen  years  of  age  my  eyes  were  tested 
and  glasses  prescribed  for  distant  use.  I  was  both 
near-sighted  and  astigmatic.  While  I  could  see  clearly 
for  near  work  I  always  seemed  to  be  under  a  nervous 
strain.  To  apply  myself  closely  to  study  and  to  con- 
centrate my  mind  and  eyesight  in  any  work  always 
left  me  nervous,  and  I  skimmed  over  the  surface  of 
everything  I  did,  never  going  deeply  into  anything, 
not  memorizing  much  of  my  recitations  which  sufficed 
for  the  day's  work.  This  strain  grew  more  marked  as 
I  grew  older  and  always  have  I  labored  under  it.  I 
went  to  numerous  oculists,  but  with  no  satisfactory  re- 
sults. 

'*At  this  time  I  suffered  from  constipation  and  sick 
headaches.  A  marked  characteristic  of  my  headaches 
has  always  been  a  full  feeling  in  the  head,  pressure 
against  the  back  of  my  eyes.  I  know  now  that  a  large 
part  of  my  discomfort  and  nervousness  was  due  to  my 
constipation  and  from  the  gas  in  the  bowels.  My 
mother  was  dead,  I  was  not  in  the  habit  of  discussing 
my  physical  troubles,  so  I  kept  them  to  myself  and 
stood  them  as  best  I  could.  I  thought  it  was  necessary 
for  some  people  to  suffer  from  troubles,  and  that  it  was 
my  weakness.  I  do  not  remember  of  doing  anything 
for  my  constipation  until  I  was  a  young  woman. 

"My  headaches  were  never  relieved  by  lying  down 
or  sleeping,  so  I  kept  on  with  my  life  under  trying  con- 
ditions many  times.  I  went  to  school  and  lived  my 
life  as  best  I  could.  While  I  walked  an  ordinary 
amount,  I  was  not  a  good  walker  and,  as  I  remember, 
was  often  conscious  of  a  dragging  weight  in  the  rectum. 

"As  I  grew  to  womanhood  I  began  the  use  of  enemas, 
laxative  waters,  and  latterly  various  drugs.  These 
gave  me  temporary  relief  only,  clearing  my  head  and 


276     Causation  and  Treatment,  Psychopathic  Diseases 

helping  my  nervousness;  but  the  reaction  came  quickly. 
I  changed  from  one  remedy  to  another,  but  was  never 
satisfied  that  I  was  getting  anything  more  than  tem- 
porary relief.  It  did  not  take  but  a  small  quantity  of 
any  medicine  to  move  the  bowels.  I  think  the  move- 
ment was  low  down  in  the  bowel. 

"All  this  time  I  was  stout,  had  good  color,  and  was 
the  picture  of  health.  I  was  married  at  about  twenty- 
four  years  of  age. 

"The  year  after  I  was  married  I  weighed  almost  one 
hundred  and  fifty  pounds.  I  was  happy,  but  my 
intestinal  trouble  continued.  There  was  much  gas 
in  the  bowels  and  pressure  in  my  head.  Part  of  the 
time  I  tried  to  ignore  it  and  part  of  the  time  attempted 
to  relieve  myself  with  enemas,  etc. 

"When  I  had  been  married  about  one  and  one-half 
years  I  had  a  severe  attack  of  cellulitis.  My  husband 
had  some  catarrhal  trouble.  At  different  times  he  had 
been  treated  for  it,  it  was  at  one  of  these  attacks  that  I 
became  infected. 

"I  was  very  ill  and  was  left  with  many  adhesions. 
I  did  not  know  why  I  did  not  recover,  but  remember 
there  was  a  feeling  of  weight  and  the  tissues  were  not 
as  free  as  formerly.  This  added  greatly  to  my  nervous- 
ness. 

"After  operation  my  nerves  felt  the  strain  of  it  all, 
and  I  realized  I  was  breaking  down.  I  went  to  a 
sanitarium  and  was  given,  in  addition  to  the  baths, 
etc.,  pelvic  massage. 

"I  kept  the  bowels  free  and  was  able  to  do  quite  a 
little  walking.  My  weight  was  much  reduced  and 
when  I  left  I  weighed  about  one  hundred  and  fifteen 
pounds. 

"For  a  few  years  I  got  on  a  little  better.  At  times 
I  would  find  a  way  of  taking  enemas  or  some  medicine 
that  would  relieve  me,  and  then  I  would  feel  better  and 


Psychognosis  of  the  Psychopathic  Substratum     277 

gain  in  weight.  At  one  time  I  weighed  about  one 
hundred  and  thirty-five  pounds  and  remember  how 
relieved  I  was  from  the  feeling  of  weight  in  the  lower 
part  of  my  body. 

"About  eight  years  ago  I  became  very  much  fright- 
ened over  my  nervous  condition :  The  medicine  I  had 
been  taking  for  my  bowels  ceased  to  be  effective;  the 
movements  were  loose  and  there  was  so  much  tighten- 
ing of  the  lower  bowels  and  much  gas. 

"I  came  to  New  York,  and  almost  immediately  upon 
my  arrival,  it  seemed  as  if  something  gave  way  in  the 
lower  part  of  my  body.  I  think  it  must  have  been  a 
weakening  and  lowering  of  the  pelvic  floor.  I  went  to 
a  gynecologist  whom  I  had  previously  consulted,  and 
who  at  one  time  had  curetted  my  uterus. 

"I  was  beside  myself  nervously,  and  thought  the 
bowel  trouble  had  been  aggravated  by  the  uterine 
condition  and,  if  something  could  only  be  done  for  that, 
I  could  get  along  with  the  intestinal  trouble.  I  knew 
nothing  of  strictures,  did  not  know  what  they  were. 
I  blame  myself  now  that  I  made  light  of  the  intestinal 
trouble. 

"The  doctor  said  he  did  not  see  why  I  was  in  such  a 
nervous  condition,  but  suggested  fastening  the  uterus 
to  the  abdominal  wall.  This  he  did,  but  he  also  at- 
tempted to  break  up  the  ovarine  adhesions  which  he 
found,  and  he  removed  the  appendix. 

"After  the  operation  I  had  more  adhesions  than  I 
had  ever  dreamed  of  before,  but  so  sure  was  I  of  my 
surgeon's  ability  that  I  believed  that  they  would  all  be 
absorbed  and  I  would  get  well.  I  was  full  of  hope,  and, 
though  under  a  terrible  nervous  strain,  gained  in  weight. 

"If  I  had  gone  to  some  quiet  place  with  my  nurse,  I 
might  have  avoided  trouble  for  a  time  at  least,  but  I  was 
induced  to  go  back  home  where  I  saw  too  many  people, 
and  kept  up  beyond  my  strength.     It  took  but  a  short 


278     Causation  and   Treatment,  Psychopathic  Diseases 

time  to  complete  my  breakdown.  I  lost  all  feeling  in 
the  lower  part  of  my  body  and  all  sensation  was  cen- 
tered around  the  right  side  of  my  body.  I  have  always 
had  more  or  less  of  it,  due,  I  think,  to  the  weakness  of 
the  nerves  and  the  pressure  of  the  gas  in  the  colon. 

"  I  went  to  a  sanitarium.  I  did  everything  to  keep 
up  all  the  time  with  the  pounding  going  on  in  my  in- 
testines; I  was  so  distressed  and  frightened  that  I  did 
not  know  which  way  to  turn.  The  uterus  finally  came 
down  and  I  had  to  get  off  my  feet  altogether,  the  con- 
gestion in  the  pelvis  was  so  great. 

I  was  terribly  distressed  in  the  lower  part  of  my 
body.  My  physician  had  discovered  a  great  deal  of  eye 
strain  and  had  both  the  horizontal  and  the  vertical 
muscles  cut.  Finally  he  sent  me  to  a  gynecologist,  and 
from  him  I  got  some  relief  and  a  little  of  my  confi- 
dence restored.  He  had  me  take  various  positions 
four  times  a  day  at  periods  of  fifteen  minutes  each,  and 
breathe  against  a  'shot  apron'  placed  across  my  abdo- 
men. This  stretched  the  adhesions,  strengthened  the 
abdominal  wall,  and  raised  the  pelvic  floor.  The  move- 
ments of  the  bowels  were  better  formed.  Since  then 
I  have  been  operated  several  times.  I  am  convinced 
that  the  sigmoid  flexure  is  at  the  bottom  of  all  my 
troubles." 

It  may  be  of  interest  to  learn  the  fact  that  as  a  child, 
up  to  the  age  of  five,  patient  lived  with  her  parents  who 
settled  as  pioneers  in  a  woodland  country,  infested  with 
poisonous  serpents  or  snakes.  One  day,  about  the  age 
of  three,  she  entered  the  house  with  a  dead,  poisonous 
snake  in  her  hands.  The  child  was  covered  with  blood. 
The  parents  were  greatly  scared.  The  child  herself 
was  not  afraid,  but  the  intense  fear  of  the  parents  was 
communicated  to  the  child,  and  this  fear  was  strongly 
impressed  on  her.  Since  then  the  child  was  in  terror 
of  poisonous  serpents,  in  fact,  of  all  kinds  of  snakes. 


Psychognosis  of  the  Psychopathic  Substratum     279 

Even  now  she  is  in  terror  of  anything  that  in  the  least 
resembles  a  serpent,  a  snake,  such  as  worms,  or  cater- 
pillars. 

Soon  after,  the  patient  began  to  have  nightmares  of 
serpents  attacking  her;  she  kills  them,  like  the  infant 
Hercules;  she  wakes  in  a  horrible  state  of  panic.  These 
dreams  have  survived  into  her  adult  life  and  manifest 
themselves  from  time  to  time,  though  not  with  such 
severity  of  terror.  It  is  quite  probable  that  the  fear  of 
the  sigmoid  flexure  is  a  survival  of  this  fear  of  her  early 
childhood,  manifested  under  different  conditions.  In 
other  words,  the  fear  of  disease  has  gradually  extended 
by  the  principle  of  metathesis,  proliferation,  irradiation, 
and  fusion,  involving  the  ancient  fear  of  childhood  on 
which  the  patient  finally  settled  unconsciously 
or  rather  subconsciously,  as  the  fons  et  origo  of  her 
malady. 


I 


CHAPTER  XVI 

PSYCHOPATHIC  FEARS 

give  here    a   series  of    quotations    from   my  pa- 
tients' accounts*: 


"I  cannot  quite  remember  when  I  commenced  to 
be  apprehensive;  possibly  it  was  seven  or  eight  years 
ago.  Whenever  I  would  feel  tired  or  nervous,  then 
any  little  pain  I  might  have  or  thought  I  had  would 
be  very  much  magnified  in  my  mind  and  would  only 
be  forgotten  after  a  visit  to  a  doctor  who  would,  as  a 
rule,  tell  me  there  was  nothing  the  matter  and  I  would 
come  out  entirely  well. 

"I  remember,  a  little  longer  than  eight  years  ago, 
I  went  to  see  a  doctor  whom  I  had  not  seen  be- 
fore. He  examined  me,  or  at  least  pretended  to,  and 
pronounced  it  diabetes. 

"My  regular  physician  was  away  at  the  time  and 
would  not  return  for  two  months,  during  this  period 
I  lost  a  great  deal  of  weight,  did  not  sleep,  and  had  to 
pass  urine  every  half  hour  or  so  as  I  remember.  When 
my  own  physician  returned,  I  went  to  see  him,  and  told 
him  the  story.  He  said  'nonsense,  there  is  nothing  the 
matter  with  you,  except  nervousness'  and  advised  me 
to  get  off  my  special  diet  and  live  a  normal  life,  which 
I  did;  and  all  the  previous  symptoms  disappeared. 

"Three  or  four  years  ago,  I  was  troubled  with  more 
or  less  sore  throat  and,  in  the  morning,  would  find  that 
the  saliva  would  contain  some  blood.     I  immediately 

*    Each  patient's  account  is  indicated  separately  by  a  Roman  numeral. 

280 


Psychopathic  Fears  281 

had  tubercular  trouble,  until  I  went  to  a  specialist  and 
was  told  that  indigestion  caused  the  throat  trouble, 
and  that  bleeding  gums  produced  the  blood. 

"I  have  had  headaches  usually  directly  over  the 
nasal  tract  in  the  middle  of  the  forehead.  I  had  heard 
of  one  who  was  similarly  affected  and  had  to  be  operated 
upon.  I  went  and  had  an  X-ray  taken  and  found 
nothing,  did  a  little  more  exercising,  and  got  my 
headaches  over. 

"Last  spring,  just  previous  to  my  going  away,  and 
at  the  height  of  my  nervous  state,  I  woke  up  suddenly 
one  night  and  found  that  my  stomach  was  very  much 
distended,  was  pressing  my  heart,  and  that  the  latter 
was  beating  most  rapidly.  I  thought  immediately  that 
I  had  had  a  shock,  but  later  when  the  physician 
called,  he  said  'no.'  The  experience  of  that  night 
however,  has  always  remained  with  me,  and  I  never  go 
to  bed  without  some  fear  that  I  may  have  a  recurrence. 
I  did  have  a  similar  attack  about  three  weeks  ago, 
without  the  vomiting,  and  it  was  only  after  taking  some 
whiskey  that  I  was  able  to  get  the  wind  out  of  my 
stomach. 

"I  have  had  cancer,  appendicitis  and  maybe  one  or 
two  other  things,  the  fear  of  which  has  at  various  times 
been  dispelled  by  physicians. 

"I  thought  once,  some  years  ago,  that  a  burglar  was 
in  the  house  at  a  time  when  I  was  alone.  I  went  and 
investigated  at  the  time  and  found  none,  but  for  the 
rest  of  the  summer,  during  which  I  lived  alone  at  the 
house  obtaining  my  meals  elsewhere,  I  always  made 
an  effort  to  arrive  home  before  dark,  to  get  the  lights 
lit  and  never  went  to  bed  during  that  period  without 
more  or  less  of  a  'creepy  feeling.' 

"This  last  summer  in  July  I  started  to  play  tennis  one 
day  and  found  that  my  heart  immediately  commenced 
to  palpitate,  but  saved  myself  as  well  as  I  could. 


282     Causation  and   Treatment,  Psychopathic  Diseases 

"After  the  match,  I  laid  down,  and  my  heart  did  not 
return  to  normal  for  a  couple  of  hours.  As  I  had  always 
played  much  tennis  in  the  previous  summers,  this 
worried  me  a  great  deal.  Later  in  the  summer  I  found 
that  in  playing  golf,  -my  heart  action  would  increase 
a  great  deal  in  the  course  of  the  game.  I  had  never  giv- 
en particular  attention  to  the  heart  before.  This  worried 
me.  I  tried  dancing  one  night,  and  I  thought  my 
heart  never  would  get  down,  and  had  to  go  out  on  the 
piazza  to  calm  it  and  myself. 

"The  result  was  that  when  I  returned  to  the  office 
in  September,  I  felt  tired,  nervous,  and  discouraged." 

II 

"When  a  child  I  always  had  an  intense  fear  of 
burglars.  I  used  to  dream  about  them  night  after 
night ,  for^j several  years.  I  also  had  a  fear  that  my 
life  was  in  danger  all  the  time.  I  was  always  sus- 
picious of  persons,  because  I  believed  that  at  any 
moment  they  might  kill  me — in  fact  I  am  always  sus- 
picious of  people  to-day,  although  I  have  no  fear  about 
being  killed.  I  am  always  afraid  that  I  am  being  im- 
posed upon  and  that  people  take  advantage  of  me.  I 
was  always  bashful  from  a  mere  child. 

"However,  when  I  got  into  high  school  I  began  to 
lose  that  characteristic.  I  always  was  unusually 
afraid  of  girls  until  I  began  to  go  to  dances  and  parties, 
and  then  my  bashfulness  wore  off  somewhat.  I  had 
appeared  before  rather  large  audiences  on  the  stage 
and  that  didn't  seem  to  trouble  me  much.  It  was 
always  when  I  came  in  close  contact  with  people  that 
I  felt  uneasy.  I  always  felt  at  a  loss  as  to  what  to  say 
to  strangers. 

"  Whenever  I  was  with  a  crowd  of  boys,  I  was  rather 
backward.    As    regard  injuries   I    only   remember    a 


Psychopathic  Fears  283 

couple.  I  was  hit  in  the  forehead  by  a  base-ball  when 
playing  catcher  on  a  team.  I  was  only  in  grammar 
school  at  this  particular  time;  I  was  knocked  down  un- 
conscious. Another  time  I  was  injured  while  playing 
hockey  on  the  ice;  I  tripped  and  fell  on  the  back  of  my 
head;  I  was  semi-conscious,  and  remained  so  for  about 
eighteen  hours.  Somehow  I  happened  to  board  a  car 
and  went  home.  I  had  to  change  cars  to  get  home  and 
I  did  all  this  in  an  automatic  manner.  The  following 
morning  I  awoke  with  a  terrible  pain  in  the  back  of 
my  head. 

"When  I  was  between  sixteen  and  seventeen,  I 
began  masturbation,  I  used  to  do  it  anywhere  from  one 
to  three  or  four  times  a  week.  It  was  very  seldom  that 
I  ever  masturbated  more  than  once  in  the  same  day. 
I  made  a  final  attempt  to  stop  masturbating.  I  suc- 
ceeded, and  have  never  done  it  since. 

"  I  was  always  more  or  less  sensitive  about  my  looks, 
because  I  knew  I  was  unusually  homely.  My  reason  for 
being  sensitive  was  because  my  relatives  on  both  sides 
of  my  family  are  considered  extremely  good  looking 
and  I  was  unfortunate  enough  to  be  born  with  such  a 
physiognomy  as  I  possessed.  Thus  I  overheard  some 
one  remark  about  me,  it  hurt  my  feelings  a  good  deal. 
When  I  went  out  on  the  street  cars,  I  was  always  the 
center  of  attraction.  I  feel  that  peculiar  feeling  in 
my  face.  My  eyes  feel  as  if  they  were  trying  to  get 
out  of  my  head.  I  also  feel  a  peculiar  irritation  in 
them.  All  this  takes  place  only  when  anyone  is  around. 
My  face  begins  to  heat  up,  I  am  conscious  every  min- 
ute while  anyone  is  around. 

"Sometimes  I  try  to  throw  the  feeling  off.  When  I 
am  outdoors  the  sensation  seems  more  intense.  When 
I  go  to  town  I  feel  that  the  eyes  of  all  the  people  are 
on  me. 

"While  in  the  public  library  one  day  last  summer,  I 


284     Causation  and   Treatment,  Psychopathic  Diseases 

accidentally  came  across  a  book  which  had  sexual  hy- 
giene. I  have  forgotten  the  title  of  the  book  and  the 
name  of  the  author  as  well,  however,  I  believe  I  could 
find  the  book  again,  if  I  went  to  the  library.  In  this 
book  I  happened  to  read  about  the  eyes  being  affected, 
if  masturbation  was  indulged  in  to  excess.  I  have 
forgotten  what  it  said  how  the  eyes  were  affected.  It 
also  said  that  after  masturbation  had  stopped,  the 
eyes  would  be  relieved  anywhere  from  six  months  to 
two  or  three  years  depending  on  how  much  the  person 
indulged  in  masturbation.  I  believe  it  said  in  some 
cases  the  eyes  were  never  cured.  After  reading  this 
and  having  my  peculiar  feeling  in  the  eyes  I  stopped 
masturbation,  because  I  feared  to  be  afflicted  with  this 
disease  all  my  life. " 

III 

"I  had  the  usual  fear  of  the  dark  common  to  all 
children.  When  put  to  bed  at  night  and  the  light 
taken  away,  the  darkness  of  the  room  seemed  peopled 
with  dreadful,  mysterious  shapes,  ready  to  spring  out 
upon  me.  If  I  relaxed  my  watch  in  the  least.  So  I  would 
keep  myself  awake,  as  it  were  by  main  force,  though  my 
eyes  would  get  so  heavy  with  sleep  that  it  was  almost 
painful  to  keep  them  open. 

"There  were  two  fears  that  stood  out  prominently 
in  my  mind  for  years,  even  past  the  time  of  childhood. 
One  was  the  fear  of  mad  dogs. 

"I  have  no  conscious  recollection  of  ever  being 
greatly  frightened  by  a  dog,  though  my  mother  says  I 
was  once  attacked  by  a  dog,  and  she  thought  that  affec- 
ted me.  At  all  events  I  had  a  perfect  terror  and  great 
fear  that  some  time  I  should  be  bitten  by  a  mad  dog 
and  die  in  that  awful  agony. 

"If  there  was  anything  in  the  papers  about  mad 


Psychopathic  Fears  285 

dogs,  I  was  sure  to  see  it  and  remember  it.  I  had 
nightmares  in  my  younger  days,  and  one  of  the  forms 
the  nightmares  took  was  that  of  a  dream  that  I  was 
being  pursued  by  a  mad  dog,  and  then  often  being 
bitten  by  him.  I  can  recall  perfectly  well,  the  over- 
whelming sense  of  relief  in  waking  up  and  finding  it 
was  all  a  dream.  As  years  went  on,  however,  all  this 
fear  gradually  left  me,  and  there  is  only  an  echo  left 
of  it  in  my  mind.  I  don't  like  to  have  dogs  touch  my 
hands  with  their  mouths  or  teeth,  I  always  give  a  wide 
berth  to  strange  dogs  out  in  the  street. 

"The  other  fear,  distinct  in  my  mind,  was  that  of 
blindness.  If  I  would  wake  up  in  the  night  and  find 
the  room  absolutely  dark  without  a  r^y  of  light,  I 
would  be  horrified  and  think  I  was  surely  gone  blind. 
I  used  always  to  take  pains  and  do  to  this  day,  to  have 
the  curtain  or  shade  drawn  in  such  a  way  that  there  was 
always  at  least  a  little  chink  left  for  the  light  to  come 
into  the  bedroom. 

"When  I  was  about  eighteen,  I  studied  Greek  one 
summer  vacation  to  make  up  work  I  had  lost  by  sick- 
ness the  previous  winter.  Shortly  after  I  began  to 
have  black  specks  before  my  eyes.  I  went  to  our  family 
physician  after  a  time,  for  one  didn't  think  so  much 
about  consulting  an  oculist  in  those  days,  and  he  at 
once  pronounced  it  'amaurosis,'  or  disease  of  the  optic 
nerve.  I  stopped  my  school  at  once.  I  was  in  the  high 
school  preparing  for  college,  and  after  a  few  months  my 
father  sent  me  over  to  spend  a  year  with  his  relatives, 
hoping  the  change  would  strengthen  my  health  and  my 
eyes.  But  this  under-current  of  fear  that  I  was  going 
blind  was  with  me  for  several  years,  though  not  enough 
to  mar  seriously  my  enjoyment  of  life.  My  mother 
says  that  my  father,  who  had  been  over-straining  his 
eyes,  thought  he  was  going  blind,  and  she  was  planning 


286     Causation  and   Treatment^  Psychopathic  Diseases 

and  turning  over  in  her  mind  what  they  could  do  to 
save  my  father's  eyesight. 


IV 


One  patient  writes: 

''^Apropos  of  my  fear  of  the  darkness  which  mostly 
passed  away  with  childhood  and  youth;  at  anothor 
period  of  my  life,  when  I  was  past  thirty,  similar  fears 
reappeared.  I  had  been  for  some  time  in  a  very  weak 
and  nervous  condition,  and  was  sleeping  downstairs 
alone.  Every  night  those  horrible  nervous  fears  would 
seize  me,  and  though  I  knew  they  were  foolish,  I  did 
not  seem  able  to  rid  myself  of  them.  It  did  not  seem 
to  be  so  much  a  fear  of  the  darkness,  per  se,  as  a  haunt- 
ing impression  that  something  was  climbing  in  at  the 
windows  of  the  next  rooms,  and  I  had  to  keep  awake 
and  on  guard,  with  every  nerve  tense.  To  quiet 
myself,  I  used  to  repeat  over  and  over,  the  91st  Psalm, 
which  I  knew  by  heart,  dwelling  especially  on  that 
verse,  'thou  shalt  not  be  afraid  for  the  terror  by  night. " 
Suddenly  and  unexpectedly  one  night,  though  the  con- 
dition remained  just  the  same,  the  burden  of  fear  was 
entirely  lifted,  and  has  never  returned. 

"I  had  a  great  shrinking  from  death,  a  fear  of  it, 
not  because  I  did  not  believe  in  God  and  a  future  life, 
and  knew  that  I  was  quite  safe  in  my  Father's  hands, 
but  more  because  I  shrank  from  going  out  into  some- 
thing unknown  and  untried,  and  especially  a  sort  of 
feeling  that  I  should  lose  my  personal  identity.  I  was 
apt  to  be  quite  apprehensive  when  I  had  little  attacks 
of  illness,  and  fear  I  was  going  to  die,  or  ponder  over 
certain  symptoms,  which  I  had  read  were  indications 
of  this  or  that  disease,  and  fear  I  had  it. " 


Psychopathic  Fears  287 

V 

One  of  my  patients  gives  the  following  account: 
"The  nervous  trouble  (feeling  of  lassitude,  fear  of  vague 
evil,  fear  of  shadows  fading  into  darkness,  intense 
depression,  loss  of  appetite  and  flesh,  insomnia,  head- 
aches, and  visceral  disturbances)  began  in  a  rudimen- 
tary way  about  a  year  and  a  half  ago,  although  I 
had  already  been  nervous,  and  was  gradually  getting 
more  so.  At  first  it  would  be  just  what  I  call  'a  painful 
thought,'  that  is,  if  I  read  something  that  was  a  story 
of  misfortune  or  suffering  of  any  kind,  or  heard  of  a  real 
case  of  similar  nature,  I  could  feel  how  the  person  must 
have  suffered,  felt  it  as  if  it  were  myself.  What  if 
that  had  been  me.''  I  shuddered  and  was  afraid.  I 
would  go  through  the  most  painful  of  all  the  sorrowful 
things  I  had  ever  read  or  known  of.  It  would  seem 
that  I  was  going  through  the  whole  experience  myself, 
and  then  I  would  hear  myself  tell  the  story  of  suffering, 
and  it  was  I  who  had  suffered  all  these  experiences. 
I  would  begin  to  believe  the  story.  When  the  end 
would  come  I  would  go  off  into  a  shivering  horror  that 
would  end  in  a  chill,  which  would  sometimes  last  for 
three  hours. 

"When  the  horror  would  come  on  I  would  go  out 
and  walk  until  I  was  tired  and  come  home  and 
go  to  bed  without  any  dinner  and  sleep,  the  sleep  of 
reaction  and  complete  exhaustion,  I  slept  apparently 
a  dreamless  sleep,  which  sometimes  lasted  about  nine 
hours.  Then  I  seemed  to  get  better  in  the  daytime, 
but  would  begin  to  dream  the  whole  thing  at  night, 
and  wake  up  in  a  blind,  shivering  terror."  The 
dreams  terrorized  the  patient,  who,  finally,  sank  into 
a  deep  physical  and  mental  depression.  As  in  many 
other  cases,  the  patient  presents  a  sensitive  organiza- 
tion, subject  to  a  series  of  shocks  dating  back  to  early 


288     Causation  and  Treatment,  Psychopathic  Diseases 

childhood.  The  terrorizing  dreams  are  hallucinations 
formed  by  the  play  of  associations  out  of  fragments  of 
actual  experiences  gone  through  during  the  periods  of 
trauma. 

VI 

"During  the  year  1907,"  a  patient  writes,  "I  took  up 
the  study  of  astronomy  and  was  much  engrossed  in 
same,  when  suddenly  an  obsession  of  the  mind  occurred 
and  which  for  the  time  being,  and  in  fact  ever  since,  put 
a  stop  to  my  study  of  this  science.  As  near  as  I  can 
recollect  I  was  not  in  bad  health  at  the  time,  but  was 
nervous  and  somewhat  worried  over  business  conditions. 
I  had  been  reading  a  chapter  in  Flammarion's  Popular 
Astronomy  about  the  earth's  motion  and  its  fall  through 
space,  instantly  the  thought  came  into  my  mind  that 
the  world  was  falling.  The  thought  of  the  fall  was 
so  impressed  on  my  mind  that  try  as  I  could,  I  failed 
to  throw  off  the  thought.  My  fear  was  in  the  falling. 
I  conceived  the  idea  that  the  world  would  bring  up 
somewhere.  I  could  about  imagine  that  I  was  falling 
with  the  world  and,  when  this  fear  was  particularly  bad, 
I  worked  myself  into  such  a  nervous  condition  that  a 
couple  of  nights  I  thought  my  chance  of  continued  life 
was  most  slim.  I  shook  off  this  condition,  and  it  left 
me  about  as  quickly  as  it  came.  I  lost  a  few  pounds 
in  weight  during  the  illness.  During  the  summer  of 
191 1  I  had  a  run  of  headaches  that  lasted  about  six 
weeks,  and  which  were  of  almost  daily  occurrence. 
At  this  time  the  thought  of  self-destruction  was  con- 
ceived in  my  mind,  making  me  somewhat  nervous,  yet 
was  not  strong  enough  to  make  any  great  impression. 
I  threw  that  thought  off  quickly  when  the  head- 
ache subsided.  This  thought  was  not  in  any  way 
acti\»e,  but  merely  the  thought  that  I  might  commit 
such  an  act. 


Psychopathic  Fears  289 

"At  M.,  the  first  two  weeks  I  was  much  depressed 
but  gained  confidence  the  third  and  fourth  weeks. 
In  the  five  weeks  there,  all  the  time  I  spent  in  my 
room  was  in  sleeping  and  the  few  minutes  once  or  twice 
a  day  to  make  a  change  of  clothing.  A  fear  which  I 
could  not  appear  to  control  kept  me  out  of  the  room. 
I  awoke  late  each  morning  with  a  most  depressed  view 
of  things,  and  I  must  admit  that  the  vigorous  exercise 
in  the  gymnasium  served  to  reduce  the  blue  feeling. 
The  sharp  knife  at  my  plate  at  every  meal  had  many 
terrors  for  me,  but  in  a  few  weeks  I  rather  gained  con- 
fidence, and  for  a  few  days  the  knife  had  almost  lost 
its  horrors  to  me.  One  day,  becoming  very  tired  after 
a  very  long  walk,  the  fear  of  the  knife  returned  and 
remained  with  me. 

After  about  two  weeks'  stay  at  this  place,  I  was  sent 
to  walk  with  a  man,  this  being  the  first  time  that  but 
two  of  us  walked  together.  About  half  way  around 
there  suddenly  came  into  my  mind  the  thought  that 
I  might  hurt  my  companion  and  that  fear  of  the 
walk  for  me  was  a  strenuous  attempt  to  combat  the 
idea,  in  which  I  failed,  as  that  fear  hung  to  me  during 
the  rest  of  my  stay.  While  walking  with  several 
people,  the  fear  would  be  with  me  just  the  same, 
and  for  a  time  I  suffered  greatly,  because  of  this 
most  unreasonable  idea.  This  fear  was  greatly  les- 
sened in  the  fourth  week  of  my  stay,  but  in  the 
fifth  week,  a  week  wherein  every  effort  appeared  to  be 
a  tiresome  one,  the  fear  returned  with  the  same  previous 
vigor.  A  day  or  two  before  I  left  M.  I  was  sent  on 
a  walk  with  a  young  man,  a  walk  of  some  miles  and  it 
was  a  miserable,  weary  walk  for  me.  The  entire  walk, 
my  mind  held  that  loathsome  fear  that  I  might  hurt 
the  young  man,  and  strive  as  I  could  I  was  unable  to 
refute  the  fear.  That  one  walk  had  undone  the  good 
work  that  I  had  accomplished   the   previous  week  in 


290     Causation  and   Treatment,  Psychopathic  Diseases 

subduing  that  particular  fear.  The  thought  of  self- 
injury  was  with  me  during  the  first  three  weeks'  stay 
there,  and  at  times  I  worked  myself  into  a  miserable 
condition,  and  I  longed  to  take  my  misery  to  some  one 
so  that  a  little  consolation  could  be  given  in  return. 
But  knowing  full  well  that  consolation  or  cheer  could 
not  be  had  from  anyone,  I  suffered  alone  in  my  misery 
and  that  such  suffering  was  of  benefit  to  me  is  extremely 
doubtful. 

"In  my  room  there  was  a  safety  razor,  my  thoughts 
often  reverted  to  this,  and  the  act  of  shaving  had  many 
fears  for  me.  I  slept  but  little  while  at  this  place.  I 
had  horrible  dreams  during  the  little  sleep  I  did  get, 
and  such  dreams  did  not  make  my  mind  the  easier  to 
be  sure." 

VII 

"The  earliest  recollection  of  my  fear  that  I  have  goes 
back  to  early  childhood.  I  heard  from  some  source 
that  wicked  people  would  be  judged  after  death  and 
irrevocably  sentenced  to  eternal  torture  in  fire,  and  this 
idea  raised  a  feeling  of  the  most  intense  horror  in  my 
mind,  lest  I  should  not  come  up  to  the  necessary 
standard  in  that  dread  day  of  judgment,  I  used  to 
resolve  to  be  good,  particularly  on  reflection  after  going 
to  bed,  that  I  would  be  better  so  as  to  escape.  How- 
ever, the  fear  was  vague  and  only  came  to  me  occa- 
sionally. 

'  'When  I  got  to  be  about  eleven  or  twelve  years  old 
the  fear  got  to  be  concrete  and  more  constant.  Then 
I  feared  that  some  remark  I  had  previously  made  about 
God  might  have  been  blasphemy  against  the  Holy 
Ghost  which  the  Bible  says  is  not  pardonable  in  this 
or  the  next  world. 


Psychopathic  Fears  291 

"This  idea  persisted  indefinitely,  but  others  came 
too.  I  feared  I  had  been  instrumental  in  the  death  of 
a  playmate,  so  a  possible  murderer,  and  the  Bible 
said  no  murderer  could  be  saved.  There  were,  be- 
sides, many  other  ideas  came  in  turn,  each  leading  to 
the  fear  of  hell  punishment.  For  instance  I  got  a  great 
fear  of  poisons  and  imagined  that  my  clothes  and  hands 
were  infected  with  poison,  and  I  feared  I  might  be 
damned  for  not  warning  people  that  I  was  a  source  of 
danger  to  their  lives,  not  having  the  moral  courage  to 
tell  them  I  might  be  covered  with  poison.  In  this  con- 
nection I  feared  my  discharge  might  be  poisonous  and 
dangerous  to  others,  therefore,  dangerous  to  my  soul. 
At  a  later  time  I  feared  I  had  not  enough  faith  for  sal- 
vation from  hell. 

"By  the  time  I  was  sixteen  years  old  I  had  become 
very  much  demoralized,  afraid  of  facing  my  fear,  and 
particularly  afraid  of  being  away  for  any  considerable 
time  or  distance  from  my  family.  In  other  words,  so 
far  as  running  up  against  my  particular  fear  was  con- 
cerned, I  had  become  an  abject  coward.  I  have  not 
by  any  means  enumerated  all  my  early  fears  up  to 
this  time,  but  the  first  definite  one  and  some  of  the 
following  leading  ones. 

"At  this  time,  the  age  of  about  sixteen,  I  became 
imbued  with  a  new  and  permanent  fear.  As  I  have 
said  I  had  become  a  great  coward  on  account  of  my 
fear,  and  I  began  to  wonder  what  would  happen  if  for 
some  great  reason  I  was  called  upon  to  exercise  courage 
and  fortitude  along  the  line  I  was  most  afraid.  I 
could  think  of  plenty  of  things  that  I  was  so  much 
afraid  to  do  that  it  took  my  breath  away  to  consider 
them  even,  such  for  instance  as  living  away  from 
family  and  friends  while  under  the  influence  of  my  fear 
and  still  more  impossible  things.  Then  the  thought 
occurred  to  me,   suppose   it  became   supremely  neces- 


292     Causation  and  Treatment^  Psychopathic  Diseases 

sary  for  me  to  make  such  asacrifice,  and  the  particular 
form  it  took  was,  suppose  it  was  necessary  to  save 
somebody  else  from  hell,  from  an  eternity  of  suffering 
against  merely  a  temporary  bit  of  pain  on  my  part. 
Then  I  went  all  to  pieces  with  fear  and  it  seemed  to 
me  that  in  the  very  nature  of  the  case  justice  must 
doom  me  for  even  having  the  slightest  doubt  about 
such  a  thing." 

VIII 

"As  a  child,  I  was  much  afraid  of  the  dark,  not  a 
rational  fear,  e.g.  of  burglars,  but  when  alone  in  a  dark 
room,  I  had  a  fear  of  some  mysterious  sort,  as  though 
something  might  pounce  upon  me.  Even  now,  if  I 
am  all  alone  in  a  house  after  nightfall,  I  feel  it  to  some 
extent.  I  remember  in  my  early  days  waking  up  at 
night  when  I  was  in  bed  alone,  the  terror  growing 
steadily  upon  me. 

"During  all  my  later  life,  the  fears  that  trouble  me 
most  aside  from  the  fears  of  blushing  already  spoken 
of  to  you,  are  fears  of  inefficiency,  of  not  coming  up 
to  the  necessary  standard  (painful  self-disparagement). 
While  I  was  first  in  rank  in  my  class  in  my  seminary 
course  and  received  marked  recognition  at  Harvard, 
where  I  studied  also  in  graduate  work,  yet  the  unsocial 
self-absorption  of  my  life  left  me  so  out  of  touch  with 
the  world  and  society  that  each  point  of  contact  im- 
pressed me  anew  with  a  fear  of  maladjustment  and 
unfitness. 

"While  during  the  present  years  I  have  become 
much  more  familiar  with  people  and  life,  and  espe- 
cially the  last  year  and  a  half  have  gained  new 
courage  in  meeting  life,  yet  the  fear  of  falling  below 
the  established  standard  of  efficiency,  is  a  thing  I 
have   constantly   to   fight   against.     Again   and   again 


Psychopathic  Fears  293 

have  dreamed  of  forgetting  to  come  to  school  in  time 
or  forgetting  about  a  whole  series  of  classes  I  was  to 
meet.  In  waking  life  there  is  a  fear  that  I  will  not  meet 
people  socially  in  an  acceptable  way,  fear  of  blushing, 
fear  I  will  fail  to  recognize  people  I  ought  to  know. 
(I  am  distinctly  deficient  in  this  matter).  If  I  read  a 
school  or  college  catalogue,  it  seems  as  though  the 
standard  of  the  courses  set,  condemned  me.  If  I  read 
a  book  on  pedagogy,  I  feel  myself  condemned  as  a  poor 
teacher,  etc.  Against  this  at  the  present  time,  is  the 
growing  confidence  that  I  am  moving  forward  to  steady 
mastery  of  life,  yet  fears  of  that  character  make  a  back- 
ground that  gives  a  tone  of  burden  and  strenuousness 
and  struggle  to  all  my  work,  making  the  free,  joyous, 
frictionless  working  a  difficult  thing  for  me  to  attain. 

"In  periods  of  depression  (not  so  much  the  last  year) 
it  seems  to  me  sometimes  that  there  was  nothing  in  the 
world  I  could  do  to  make  a  living  except  teaching,  and 
that  I  was  so  unfit  to  teach,  it  was  a  question  whether 
I  ought  not  to  resign. 

"I  talked  once  to  a  principal  of  our  school  about  the 
trouble  I  had  had  about  flushing,  and  said  I  felt  doubt- 
ful whether  I  ought  to  keep  my  position,  but  he  did  not 
take  the  same  view  of  it.  My  view  of  things  would 
be  sharply  diiferent  in  certain  periods  of  depression  and 
weakness. " 

IX 

"I  have  always  felt  faint  whenever  I  have  had  any 
kind  of  examination,  for  insurance,  gymnasium,  or  by 
my  own  doctors.  I  never  could  listen  to  stories  of 
operations  without  being  obliged  to  get  up  and  leave 
the  room. 

"The  sight  of  blood  from  a  cut  finger  is  apt  to  make 
me  feel  faint. 


294     Causation  and   Treatment,   Psychopathic  Diseases 


"I  had  my  tonsils  taken  out  several  years  ago.  On 
my  way  home  I  could  feel  that  there  was  a  slight  bleed- 
ing going  on  in  the  back  of  my  throat,  I  became  panicky, 
had  to  stand  by  the  door  of  the  car  where  there  was  more 
air,  and  would  have  given  a  great  deal  to  be  at  home. 
"Occasionally,  on  the  street  I  have  felt  as  though  the 
blood  was  leaving  my  head,  and  that  I  might  faint,  and 
my  inclination  has  been  to  lean  against  a  building  for  a 
few  moments  until  the  feeling  would  be  past.  In  all 
these  panicky  times  my  heart  would  beat  more  rapidly, 
and  perspiration  would  come  out  on  my  body. 

"When  playing  bridge,  during  an  important  turn  of 
the  game  my  heart  would  commence  to  beat  fast,  I 
would  get  short  of  breath,  and  I  would  be  obliged  to 
get  up  and  walk  around  some,  or  frequently  I  would 
take  some  sodium  bicarbonate  which  would  seem  to 
help  me  collect  myself. 

"These  attacks  at  bridge  have  only  been  noticeable 
during  the  last  five  or  six  months  and  did  not  always 
occur  when  I  was  playing. 

"I  have  always  figured  that  my  nervousness  had 
brought  on  indigestion,  then  would  follow  the  increased 
heart  beat  and  the  resulting  panicky  feeling  which  was 
akin  to  fainting  in  my  mind. 

"The  only  incident  I  can  remember  that  might  have 
a  bearing  on  my  being  afraid  in  the  dark  was  when  I 
was  in  the  West  at  sixteen  or  seventeen  years  of  age. 
I  lived  alone  in  a  home  in  the  suburbs  for  a  time, 
obtaining  my  meals  at  the  hotel  in  town.  I  used  to 
dread  going  to  that  home  every  night,  but  I  had  to, 
and  did.  It  was  during  this  time  that  a  burglary  oc- 
curred. I  really  do  not  remember  being  afraid  of  the 
dark  before  this  period. 

"There  is  another  weakness  which  has  troubled  me 
and  that  is  that  I  am  very  apt  to  exaggerate,  and  not 
tell  the  exact  truth  even  when  no  consequence  could 


Psychopathic  Fears  295 

possibly  follow  the  telling  of  the  exact  facts.     This 
has  troubled  me  very  much. 

"Then  there  are  some  words  that  I  cannot  pronounce 
distinctly  except  with  extreme  care,  and  I  have  felt 
for  some  time  that  it  indicated  a  gradual  breaking  up 
of  my  mental  powers. 

"About  a  year  ago  an  associate  of  mine  in  business 
had  a  complete  nervous  and  physical  breakdown. 
I  had  considerable  to  do  for  him  at  the  time,  and  finally 
took  him  with  his  nurse  out  to  a  sanitarium  in  Framing- 
ham.  His  condition,  action,  and  appearance  during 
that  ride  are  always  recurring,  and  the  fear  that  some 
day  I  may  be  in  similar  shape  occasionally  comes  to 
me.  He  has  since  recovered  as  far  as  his  mentality  is 
concerned,  although  his  physical  condition  is  not 
good. 

"I  frequently  think  out  possible  accidents  to  the 
children.  If  my  boys  ride  to  school  on  their  bicycles 
in  the  morning,  I  worry,  thinking  that  an  automobile 
may  run  over  them.  If  a  child  slides  down  a  balus- 
trade, I  worry  for  fear  he  may  do  it  some  day  and  fall 
off  and  hurt  himself.  When  my  children  have  been 
sick,  I  have  worried  and  have  always  wanted  to  send 
for  the  physician  on  the  slightest  pretense. 

"When  our  last  child  was  born,  my  wife  toward  the 
end  showed  evidence  of  kidney  trouble.  The  doctor 
would  not  let  her  know,  but  told  me.  I  did  not  feel 
that  he  was  giving  the  case  proper  attention  and  in- 
sisted on  a  specialist  being  called  in.  The  latter 
arrived  as  my  wife  was  going  into  a  first  convulsion. 
The  baby  was  of  course  taken  right  away,  but  my 
wife  had  a  very  narrow  escape.  This  experience  was 
almost  a  nightmare  for  months  after. 

"I  could  not  seem  to  take  a  logical  point  of 
view.  Instead  of  being  thankful  that  my  wife  and 
baby  had  been  saved,  the  predominating  thought  was 


296     Causation  and   Treatment,  Psychopathic  Diseases 

rather,  what  if  the  specialist  had  not  come,  what  if 
anything  had  happened  to  my  wife,  what  would  or 
could  I  have  done  for  the  other  children  in  case  the 
worst  had  happened. 

"Even  now  when  I  think  of  my  wife  and  children, 
instead  of  the  thought  of  them  making  me  brace  up 
and  determine  to  get  strong  for  their  sake,  my  inclina- 
tion is  to  weaken,  get  blue  and  down  in  the  dumps. 

' '  I  had  a  considerable  shock  about  nine  months  ago. 
Lightning  struck  a  house  where  my  wife  and  I  were 
staying,  and  from  the  shingles  and  plaster  which  I  saw 
coming  down  I  felt  that  the  room  we  occupied  was  most 
struck. 

"I  commenced  to  have  palpitation,  felt  weak  as  a 
rag,  and  only  with  difficulty  could  I  get  upstairs.  I 
found  my  wife  had  stopped  on  the  way  in  the  corridor 
to  speak  to  some  one  and  was  not  near  her  room,  which 
we  found  was  the  one  struck. 

"The  memory  of  that  incident  constantly  came  back 
to  me.  Again,  instead  of  the  thread  of  thought  running 
along  thankful-it-is-over-and-no-one-hurt  lines,  I  kept 
thinking  of  the  consequences  had  the  facts  been 
different. " 

X 

"The  first  fright  I  remember  was  at  the  age  of  three, 
when  one  of  my  brothers  accidentally  discharged  a  gun 
wounding  a  woman  in  the  room  where  I  was,  since 
which  time  I  have  always  experienced  a  great  terror  at 
the  sight  of  a  gun  or  pistol,  even  in  a  moving  picture 
show.  Also  until  recently  the  sight  of  blood  has  greatly 
terrified  me,  always  causing  a  feeling  of  faintness. 

"Not  long  after,  lightning  entered  the  room  where  I 
was,  breaking  a  window  and  giving  us  a  shock. 

"At  the  age  of  four  and  a  half  my  mother's  sister, 


Psychopathic  Fears  297 

who  lived  near  us,  died  after  a  short,  severe  illness. 
I  overheard  the  news  of  it,  and,  as  I  recall  the  full 
significance  of  it,  it  seemed  to  impress  me  and  I  cried 
for  several  hours  until  my  parents  returned  with  the 
little  girl  cousin  who  always  afterward  lived  with  us. 

"A  little  before  I  was  nine  we  moved  to  the  village 
of  Adrian.  I  had  began  to  stutter  at  this  time  and  for 
the  first  time  was  teased  about  it  by  two  or  three  of  my 
playmates;  this  distressed  me  very  much,  though  I 
never  spoke  of  it  to  teacher  or  the  family.  It  was 
rather  a  trying  ordeal,  to  have  names  shouted  after  me 
even  on  the  street,  by  children  three  or  four  years  older 
than  myself. 

"About  the  age  of  twelve,  while  out  with  a  picnic 
party,  we  attempted  to  cross  a  long  railroad  bridge, 
and  the  train  surprised  us  while  crossing.  Fortunately 
no  one  was  injured,  though  several  of  us  had  to  jump 
a  considerable  distance.  I  did  not  jump  until  the 
train  almost  reached  me,  when  I  fell,  left  my  basket 
on  the  track,  and  barely  escaped  injury.  I  remember 
being  too  unnerved  to  walk  for  some  time,  and  that  a 
couple  of  hours  later  someone  remarked  that  I  was  still 
trembling. 

"Perhaps  a  year  or  two  later,  or  possible  the  winter 
following,  while  we  were  playing  with  our  sleds  at  school, 
one  of  the  big  boys  seized  mine  and  ran  with  it  across 
a  deep  narrow  ditch,  throwing  me  off"  so  violently 
that  for  some  little  time,  perhaps  ten  minutes,  I  was 
unable  to  move  and  they  carried  me  into  the  school 
room.  From  this  time  on  for  several  years  I  had 
considerable  trouble  with  my  back.  It  grew  tired 
easily  and  would  pain." 

XI 

"As  you  are  desirous  of  knowing  more  about  my 
life  and  environment,  I  will  state  concerning  them,  as 
follows : 


298     Causation  and   Treatment^  Psychopathic  Diseases 

"You  will  remember  that  I  told  you  that  my  step- 
father was  a  liquor  dealer.  Throughout  all  the  time 
that  he  was  in  business  we  either  lived  over  the  bar- 
room or  else  lived  right  in  the  place  where  the  liquor 
was  sold.  My  step-father  was  a  heavy  drinker,  a  man 
of  violent  nature,  and  decidedly  pugnacious.  As  a 
child  I  have  been  scared  to  death  by  drunken  brawls, 
and  many  nights  have  I  been  dragged  out  of  bed  by 
my  mother  who  would  flee  with  me  to  the  house  of  a 
neighbor  for  safety. 

"I  might  say  that  until  I  was  seventeen  years  old, 
I  lived  in  continual  terror  of  something  going  to 
happen.  If  he  was  arrested  by  the  police,  as  often 
happened,  our  home  would  be  the  scene  of  turmoil 
until  the  case  was  settled. 

"I  remember  one  incident  very  plainly,  when  he 
came  home  one  night  completely  covered  with  blood 
as  the  result  of  being  held  up  by  thugs,  ajid  another 
time  when  he  left  the  house  to  subdue  some  quarreling 
drunks  with  a  pistol  and  returned  after  an  exchange 
of  shots  with  his  hand  shot  through. 

"As  a  child,  I  was  inclined  to  study, and  associated 
very  little  with  other  children.  My  mother  tells  me 
that  I  talked  early,  but  when  about  three  years  old  I 
began  to  stammer.  This  trouble  bothered  me  a  great 
deal  and  I  used  to  worry  about  it  all  the  time,  especially 
in  school  when  I  would  try  to  recite.  I  might  add 
that  even  now,  when  excited,  I  am  troubled  in  the 
same  way. 

"My  step-father  has  been  subject  to  nightmares 
nearly  all  his  life;  when  asleep  he  would  cry  and  moan 
and  would  be  unable  to  move  until  someone  would 
shake  him  out  of  it.  He  was  terribly  afraid  of  them, 
and  I  remember  he  used  to  say  that  he  expected  to  die 
in  one  of  them.  I  used  to  be  left  alone  with  him  quite 
frequently,  and  I  stood  in  constant  fear  of  his  dying; 


Psychopathic  Fears  299 

and  If  he  fell  asleep  (as  he  frequently  did  in  the 
daytime)  I  would  either  wake  him  or  watch  his  respira- 
tion to  see  if  he  was  alive.  At  other  times,  I  have 
been  awakened  In  the  night  by  his  cries  and  would 
assist  my  mother  in  bringing  him  to  consciousness. 
It  was  during  one  of  these  times  that  I  became  aware  of 
my  heart  palpitating,  and  whenever  he  had  such  a  spell, 
I  would  be  in  a  state  of  fear  and  excitement  for  some 
time  after.  He  would  have  these  nightmares  nearly 
every  night  and  sometimes  four  or  five  times  in  one 
night;  and  I  might  add  that  he  has  them  even  now. 

"I  began  to  have  attacks  of  dizziness  in  the  streets, 
and  finally  one  day,  I  had  one,  and  all  symptoms  and 
fears  of  the  attack  in  school  came  on,  and  from  that 
time  on  I  have  watched  my  respiration  and  suffered 
from   dizziness,    and   mental   depression   and   sadness. 

"You  have  asked  me  to  tell  you  more  in  detail  about 
the  attacks  or  nightmares  to  which  my  step-father  was 
subject  and  which  always  frightened  me  greatly, 
especially  when  a  child. 

"My  step-father  had  the  habit  of  falling  asleep  quite 
often,  even  In  the  daytime,  and  I  have  never  known 
him  to  go  to  sleep  without  having  an  attack  in  some 
form.  If  one  watched  him  asleep,  as  I  often  did,  one 
could  tell  by  his  respiration  when  an  attack  was  coming. 
His  breathing  would  become  slower  and  hardly  per- 
ceptible, and  finally  he  would  begin  to  moan,  and  cry 
out;  then,  when  shaken  vigorously  and  spoken  to,  he 
would  awaken  In  great  fear  and  apparent  sufi"ering. 
If  he  had  an  attack,  and  we  did  not  respond  soon 
enough,  he  would  be  very  angry  and  say  that  we  cared 
not  if  he  should  die.  We  were  so  afraid  of  these  attacks 
that  we  had  trained  ourselves  to  be  ever  on  the  look-out 
for  his  cries,  even  at  night. 

"It  really  seemed  as  if  his  life  rested  in  our  hands. 
I  might  say  that  sometimes  these  attacks  lasted  several 


3CXD     Causation  and   Treatment,  Psychopathic  Diseases 

minutes  before  he  could  be  awakened.  He  used  to  say 
that  at  such  times  he  always  dreamed  someone  was 
choking,  beating,  or  otherwise  torturing  him.  He  had 
been  told  by  some  physician  that  he  would  ultimately 
die  in  such  an  attack. 

"These  attacks  were  sufficient  to  precipitate  a  small 
panic  in  the  house.  I  know  not  a  single  hour  of  day 
or  night,  but  that  I  have  either  been  called  or  awakened 
by  my  mother  in  her  efforts  to  awaken  him.  With 
the  attack  over,  I  would  be  trembling  all  over,  and  my 
heart  would  be  beating  madly.  I  can  remember  these 
attacks  from  my  earliest  childhood  and  it  seems  to 
me  that  on  one  occasion,  at  your  office,  I  was  startled 
just  as  these  attacks  used  to  make  me. " 

While  in  the  hypnoidal  state  patient  exclaimed: 
"I  am  afraid.  .  .  All  my  life  I  lived  under  terrible 
fear".     .     .     .     "Thisis  just  my  disease fear ." 

xn 

"I  have  a  fear  of  going  home,  and  I  fear  being  away; 
I  am  not  particularly  afraid  of  anything,  yet  I  always 
have  a  thought  or  a  fear;  whenever  I  undertake  to  do 
anything,  there  is  a  queer  imagination  about  it.  I 
think  of  childhood  thoughts;  if  I  see  buildings,  they 
look  to  me  like  sanitariums,  which  are  very  distasteful. 
There  is  nothing  that  seems  the  same  to  me,  no  matter 
what  it  is.  I  seem  to  have  little  sense  and  not  much 
memory  when  I  am  doing  anything;  sounds  startle 
me  as  if  it  was  something  else,  and  if  it  were  something 
I  see,  a  coat  or  any  garment,  it  will  sometimes  startle 
me  as  if  it  were  a  person;  or,  looking  at  a  beautiful 
piece  of  art  work  or  picture,  I  can  see  nothing  but  the 
wrong  part  and  a  very  distasteful  thought  with  It, 
which  I  never  had  because  we  were  lovers  of  art,  as  It 
was  our  line  of  business.     I  never  had  these  thoughts, 


Psychopathic  Fears  301 

that  is,  I  never  noticed  them  when  well.  A  few  months 
after  I  was  sick  my  brothers  would  accuse  me  of  over- 
indulgence, also  my  mother,  as  she  never  liked  her 
sons'  wives. 

"J  know  that  ever  since  I  was  told  of  our  stenographer 
I  was  afraid  of  hurting  a  baby;  if  I  would  be  around 
my  sister's  dear  little  one,  I  would  get  nervous  and 
leave  the  room  for  fear  I  would  hurt  it. 

"All  my  nervousness  seems  to  come  from  my  fears. 
Even  in  seeing,  hearing,  smelling  etc.,  there  is  nothing 
I  am  really  afraid  of,  my  fears  seem  to  be  imaginary. 

"Ever  since  I  can  remember  I  always  had  a  fear, 
no  matter  where  I  went,  but  I  learned  to  be  brave. 
I  often  heard  my  father  say  that  I  was  afraid  to  walk 
until  I  was  four  years  old,  but  he  said  I  was  always  good 
and  pleasant. 

"There  were  seven  of  us;  my  mother  was  hard  of 
hearing,  and  the  children  could  learn  and  hear  bad 
things  without  her  knowledge.  In  school  I  was  very 
bright,  especially  in  arithmetic  and  history.  I  always 
had  the  first  seat  in  school. 

"After  getting  through  the  Intermediate  school,  I 
learned  the  granite  trade  which  was  very  hard  work, 
also  tool  dressing  for  stone  cutters,  which  I  learned 
rapidly;  but  always  feared  I  could  not  do  enough,  or  it 
was  not  well  enough. 

"The  men  I  served  my  apprenticeship  to  were  vul- 
gar and  drinkers,  as  such  men  are  as  a  rule.  I  was 
never  very  stout,  rather  small,  but  quick. 

"The  reason  for  starting  to  work  so  early  in  life  was, 
because  we  were  poor  and  my  father  was  dead  and  I 
was  allowed  to  do  as  I  pleased  on  account  of  mother's 
condition,  being  deaf.  All  the  brothers  learned  the 
same  trade,  after  which  four  of  us  started  a  little  shop, 
and  it  grew  with  our  hard  work;  we  aimed  to  do  a 
high  class  of  work,  being  practical.     We  soon  estab- 


3C2     Causation  and   Treatment,  Psychopathic  Diseases 

lished  a  nice  respectable  business,  and  then  it  was 
necessary  for  one  of  us  to  travel  as  salesman  on  the 
road,  so  the  burden  fell  to  me,  which  I  stuck  to  for 
several  years,  and  was  thrown  in  with  lots  of  good  and 
bad  company,  and  got  to  drinking,  as  I  think  now,  too 
much. 

"There  being  four  of  us,  when  we  did  things,  we 
were  afraid  to  tell,  for  we  were  afraid  of  being  scolded. 
I,  being  of  tender  heart  and  easily  affected,  would 
never  tell  anything  and  it  was  nothing,  as  men  do 
every  day,  drink  and  have  a  little  fun,  but  I  never 
did  anything  wrong.  If  I  went  with  a  girl,  my  mother 
would  always  scold  about  it  and  also  my  brothers. 
This  opposition  always  broke  me  down,  but  I  still  went 
with  the  girl  for  several  years,  and  finally  I  married 
her  five  years  ago,  under  great  protest  and  fear. 
I  loved  her  as  she  was  noble  and  good,  but  mother 
could  never  forgive  her  sons  for  marrying  and  contin- 
ually fussed  about  it,  which  I  think  kept  me  unhappy 
and  I  would  drink. 

'  'Whenever  I  took  the  grip,  I  always  thought  I  was 
going  to  die.  In  a  few  days  I  would  be  all  right  and 
would  go  and  hustle,  either  doing  hard  work  or  selling 
goods. 

"Last  January,  we  noticed  some  one  had  been  using 
our  autos  and  my  brother  let  the  police  know,  so  one 
night  at  twelve  o'clock,  they  caught  them,  four  men, 
and  took  them  to  the  jail.  One  of  them  was  a  young 
fellow,  a  driver  of  ours,  and  I  felt  very  sorry  for  him, 
lying  in  jail  and  feared  he  would  be  sent  to  the  peni- 
tentiary which  I  could  not  bear. 

"I  had  a  fear,  for  just  a  few  evenings  before  that  I 
and  another  friend  had  taken  his  mother  and  sister 
out  for  a  ride,  for  they  had  pleaded  for  an  auto  ride, 
all  of  which  I  told  my  wife,  as  there  was  nothing 
wrong. 


Psychopathic  Fears  303 

"I  feared  she  would  make  up  some  slander  against 
me,  to  save  her  brother,  and  I  was  very  nervous,  but 
still  there  ought  not  have  been  any  worry  on  my  part, 
there  was  nothing  wrong.  I  felt  sorry  for  the  boy 
and  was  afraid  of  false  slander.  I  would  drink  to 
rest  my  nerves,  but  did  not  think  so  at  the  time,  for 
I  did  not  know  what  nerves  were. 

'*0n  the  20th  of  February  1914, 1  took  to  bed  thinking 
I  had  a  cold  or  grip  and  was  frightened  to  death,  for  I 
thought  I  had  pneumonia  one  day,  Bright's  disease  the 
next,  because  I  thought  I  drank  too  much,  and  the 
doctor  assured  me  that  there  was  nothing  the  matter 
with  me,  except  a  little  fever,  grip  or  bronchitis,  and  I 
imagined  I  had  everything,  for  I  had  a  terrific  pain 
in  my  heart  which  made  my  arm  straighten  out.  In 
a  few  days  I  got  up  and  was  nervous,  but  I  thought 
it  was  from  drink  and  I  never  told  the  doctor  for  fear 
of  my  parents  and  wife. 

"A  few  weeks  after  my  nervousness  our  typewriter 
gave  birth  to  a  child  and  my  brothers  asked  me  if  I  was 
responsible,  and  I  told  them  'No',  but  I  worried,  think- 
ing she  may  blame  it  on  to  me,  for  I  was  perfect- 
ly innocent,  but  could  not  help  worrying  as  I  was 
nervous.  A  few  weeks  after  my  illness  I  went  to  B. 
with  my  brother,  and  when  the  public  found  it  out 
some  one  put  it  in  a  yellow  sheet,  saying  that  I  had 
gone  to  a  sanitarium  over  the  condition  of  our  stenog- 
rapher. I  think  all  this  gave  me  a  set-back,  for  I  could 
not  bear  to  hear  a  newsboy,  and  was  afraid  of  women 
for  a  long  time.  All  the  old  vulgar  tales  I  heard  and 
things  I  saw  hurt  me. 

"I  can't  sleep  nights  unless  I  take  medicine,  and 
when  I  wake  I  have  so  many  uncontrollable  thoughts. 
My  mind  never  stops,  and  now  I  begin  to  imagine  things 
are  alive  and  all  sorts  of  illusions  trouble  me.  I  always 
thought  I  never  would  get  well  after  fighting  so  hard 


304     Causation  and  Treatment^  Psychopathic  Diseases 

for  ten  months,  with  all  the  best  doctors  to  help  me. 
Even  when  I  work  I  fear  I  am  doing  something  else. 
"At  times  I  want  to  get  well  and  be  happy  again. 
I  went  to  a  doctor  and  I  overheard  him  tell  my  mother 
that  my 'sensory  nerves  were  functionally  affected.' 
I  always  thought  I  drank  too  much.  I  had  a  bad 
sickness  fifteen  years  ago  of  a  sexual  nature,  but  was 
never  bothered  with  it  since.  I  weighed  two  hundred 
pounds  before  T  broke  dov/n.  The  doctor  says  that 
it  was  bloat  a  good  deal.  I  may  have  been  nervous  a 
long  time  before  I  knew  it,  I  would  drink  and  probably 
that  brought  me  to  this  fearful  state.  *' 

XIII 

"I  was  bred  in  fear  from  my  childhood.  My  train- 
ing and  education  were  essentially  religious,  of  an 
authoritative  and  terrorizing  character.  I  was  told 
all  sorts  of  ghost  stories,  stories  of  murders,  highway 
robberies,  and  other  horrible  tales  by  the  ignorant  and 
superstitious  servants  and  people  with  whom  I  came 
in  contact  when  a  child.  Many  times  when  in  the 
dark  I  fancied  spirit  folk  haunting  the  place.  I  some- 
times felt  like  screaming  with  terror.  I  often  used  to 
hear  mysterious  voices  and  sounds  which  I  ascribed 
to  spirits.  At  night,  I  would  often  in  my  fear  cover 
my  head  with  my  blanket,  bury  my  head  in  the  pillow 
and  shiver  with  fear.  I  was  afraid  of  darkness,  of 
secluded  places,  of  the  cellar,  of  the  loft,  of  the  lonely 
barn,  of  the  church,  of  the  church  yard,  and  more 
especially  of  the  cemetery.  Had  I  been  left  alone  in 
such  places  I  would  have  fainted  from  terror.  My 
mind  was  filled  with  superstitions  of  all  the  horrible 
accidents  that  may  happen  to  one  under  such  condi- 
tions. 

"There  was  a  strong  feeling  of  self  in  the  fear,  inas- 


Psychopathic  Fears  305 

much  as  I  was  in  terror  of  death,  and  of  illness  that 
may  bring  about  death.  I  have  witnessed  in  my  child- 
hood a  great  many  deaths  in  the  family.  The  agonies 
of  the  dying  left  a  deep  impression  on  me.  I  was 
afraid  of  death,  and  more  still  of  the  mystery  of  death. 
This  fear  is  now  as  strong  in  me  as  ever, — it  is  a  morbid 
fear,  giving  rise  to  intense  agony  and  anxiety.  The  very 
mention  of  illness  and  death  is  enough  to  arouse  the 
fear,  and  if  the  fear  is  left  uncontrolled,  the  most  excru- 
ciating anxiety  and  agony  may  be  awakened,  rising  to  a 
veritable  frenzy  of  terror. 

"This  fear  of  threatening  illness  and  death,  whether 
in  myself  or  in  my  family,  may  rise  to  such  an  acute 
stage  as  to  drive  me  to  drink,  so  as  to  counteract  the 
emotion  by  some  form  of  reaction.  Drink,  however, 
does  not  agree  with  me.  A  few  teaspoonfuls  of  brandy 
or  of  whiskey  are  enough  to  upset  my  stomach  or  my 
intestinal  tract,  and  I  may  vomit,  or  I  may  just  feel 
nauseated  for  a  long  time,  and  vomit,  if  I  take  a  couple 
more  teaspoonfuls.  Sometimes  the  very  smell  of 
brandy  is  enough  to  make  me  feel  nauseated.  I  have 
formed  a  fear  of  alcoholic  drinks,  even  wine  is  apt  to 
upset  me.  There  is  no  way  of  overcoming  my  agoniz- 
ing fears.     Everything  with  me  turns  into  fear. 

"Even  the  sexual  side  of  my  life  is  associated  with 
fear.  I  was  afraid  to  come  near  women  for  fear  of 
infection,  I  used  to  be  in  agonies  of  fear  of  possible 
infection  for  days  and  weeks  together.  Marriage  did 
not  seem  to  improve  matters.  Intense  headaches  are 
associated  with  sexual  functions  so  that  I  am  afraid  of 
ruining  my  brain,  my  nerves,  my  health,  and  getting 
paralysis,  or  sinking  into  imbecility  and  dementia,  in 
spite  of  the  assurance  of  my  physicians  to  the  contrary. 

"The  fear  of  possible  infection,  bringing  a  fearful 
malady,  ending  in  a  miserable  death  specially  haunts 
me   of   late.     The    least   cut,    the    most   insignificant 


3o6     Causation  and  Treatment^  Psychopathic  Diseases 

scratch  is  apt  to  bring  about  an  attack  of  fear.  Shaking 
hands  with  strangers,  especially  drinking  from  a  dish, 
touched  by  a  strange  person,  is  enough  to  set  me  in  a 
paroxysm  of  terror.  Sometimes  it  is  enough  to  read  in 
a  paper,  or  to  hear  of  sickness,  or  of  an  epidemic,  to  stir 
up  my  morbid  fear  of  sickness  and  death. 

"When  I  look  down  from  some  high  place,  I  feel  a 
sort  of  sinking  in  my  stomach.  I  am  in  agony  of  fear. 
The  fear  becomes  sometimes  so  intense,  that  I  feel 
dizzied,  stagger,  feel  like  throwing  myself  down,  and 
put  an  end  to  the  misery  of  my  fear. 

"I  am  afraid  to  board  a  car  or  a  train.  I  am  afraid 
I  may  fall  out  and  get  killed,  in  fact  this  has  actually 
happened  to  me.  I  was  nearly  killed  in  accidents,  once 
in  my  childhood,  and  another  time  in  my  youth. 

"In  attempting  to  induce  a  state  of  intoxication 
I  have  often  felt  severe  nausea  and  vomiting.  Re- 
cently somebody  told  of  cancer  of  the  stomach  giving 
rise  to  vomiting.  I  examined  my  vomitus  and  I  found 
some  red  specks, — they  were  really  something  of  the 
food  taken — I  became  so  terrified  that  I  felt  like  one 
benumbed  with  fear,  I  was  paralyzed  with  fear.  All  I 
knew  and  heard  of  cancer,  of  the  suffering  and  death 
came  clearly  before  my  mind  and  overwhelmed  me 
with  a  flood  of  blind  fear. 

"While  I  write  this  account  for  you  a  mosquito 
hovers  round  me.  I  am  afraid  of  this  mosquito,  having 
heard  and  read  of  the  terrible  diseases  these  insects 
communicate  to  people.  When  I  kill  a  fly  I  have  to 
keep  on  washing  my  hands  endlessly, — I  am  afraid 
perhaps  the  fly  carried  some  terrible  infection. 

"The  sight  of  blood  is  apt  to  make  me  faint.     I  think 

of  sickness  and  death.     Blood  is  to  me  the  shedding  of 

blood,   it   is   death.     Sometimes   this   feeling  is   quite 

strong  with  me,  and  sometimes  I  just  feel  apprehensive 

or  a  short  time  until  some  other  fear  takes  its  place. 


Psychopathic  Fears  307 

"What  makes  me  specially  apprehensive  is  the  fact 
that  the  fear  tends  to  spread  to  more  and  more  objects 
and  interests  of  life.  My  fears  grow  and  become  more 
extensive  involving  more  parts  of  my  being.  I  am 
afraid  that  the  fears  will  finally  end  by  paralyzing  all 
my  vital  activities.  What  then?  To  escape  my  ob- 
sessions I  employ  all  kinds  of  subterfuges.  I  get  no- 
where. I  avoid  one  fear  only  to  get  into  another.  J 
become  more  and  more  entangled  in  the  mesh  of  fears, 
like  a  fly  in  a  spider's  cobweb.     My  life  is  h-11. " 

XIV 

"I  had  a  fear  of  a  peculiar  steamboat  whistle;  I  had 
fears,  during  a  certain  period,  of  the  end  of  the  world; 
and  I  was  afraid  of  harshness  or  unkindness.  I  have 
been  more  fearful  than  other  people,  I  have  been 
anxious  about  many  things.  I  may  say  that  I  think 
my  fears  have  always  been  along  the  line  of  my  ideals, 
as  soon  as  I  began  to  have  any.  Thus,  in  early  child- 
hood I  thought  nothing  of  the  future,  and  my  fears 
were  consequently  limited  to  my  present  personal 
comfort.  I  may  not  have  heretofore  mentioned  that 
I  was  always,  at  least  after  nine  or  ten  years  of  age, 
rather  timid  before  strangers.  I  shrank  from  harshness 
and  abruptness  in  tone  and  manner. 

"With  the  onset  of  malaria,  between  the  ages  of  nine 
and  twelve,  I  naturally  thought  more  of  the  subject  of 
disease,  but  even  then  my  fears  were  directed  princi- 
pally, if  not  wholly,  to  the  particular  trouble  which 
was  present.  I  worried,  because  the  chills  could  not 
be  broken.  I  also  had  fear  of  kidney  trouble  about 
that  time,  and  a  little  later,  I  had  a  fear  of  seminal 
emissions. 

"A  general  sense  of  self-distrust  began  to  show  itself 
when  I  first  realized  that  I  was  being  raised  differently 


3o8     Causation  and   Treatment,  Psychopathic  Diseases 

from  other  boys  and  was  being  criticized  in  consequence, 
and,  furthermore,  that  I  could  not  feel  at  home  in 
their  company,  due  to  my  ignorance  of  their  life  and 
their  ignorance  of  mine.  Since  then,  many  causes 
have  conspired  to  make  me  timid,  among  which  had 
been  my  sexual  life. 

"All  through  my  later  life,  whenever  the  importance 
of  health  has  been  emphasized  in  my  thinking,  my 
anxieties  have  run  in  that  direction,  and  I  have  feared 
that  I  would  not  be  physically  strong  enough  for  the 
battles  of  life.  Whenever,  as  between  the  ages  of 
fourteen  and  twenty  especially,  T  have  dwelt  much  in 
thought  upon  the  importance  of  living  in  accord  with 
religious  precepts,  I  have  feared  that  I  should  deviate 
therefrom — especially  as  there  appeared  to  be  looming 
up  in  my  life  a  very  powerful  temptation.  When, 
later  on,  I  lost  faith  in  the  supernatural  element  in 
religion,  there  still  remained  the  intense  fear. " 

XV 

"During  my  boyhood  I  was  more  or  less  persecuted 
by  a  conviction  that  if  I  did  not  go  downstairs  in  a 
certain  way  I  should  be  hung,  or  that  if  I  did  not  touch 
every  post  in  a  certain  fence  I  was  passing,  something 
alarming  would  happen  to  me,  and  I  have  been 
interested  to  learn  since  that  others  have  had  similar 
delusions,  notably  Samuel  Johnson,  the  English  writer. 

"After  graduating  from  the  medical  school,  I  talked 
with  men  who  were  going  to  various  parts  of  the 
country  to  practice,  and  it  was  a  matter  of  astonish- 
ment to  me  that  these  men  could  contemplate  going 
far  away  from  home  and  friends,  especially  to  engage 
in  such  a  profession  which  I  personally  felt  about  as 
competent  to  engage  in  as  a  ten-year-old  boy.  I  could 
not   even    induce  myself  to  take    a    position    in   the 


Psychopathic  Fears  369 

hospital  in  Boston,  although  I  felt  that  it  would  be  an 
excellent  thing  for  me.  I  was  afraid  of  the  unclean, 
ugly  diseases,  the  maimed  bodies,  the  contact  with 
the  patients  and  the  internes  and  physicians  who  under- 
stood and  enjoyed  those  things  which  simply  terrified 
me — so  I  went  home. 

"I  had  much  time  on  my  hands  and  had  periods  of 
great  despondency  and  fear,  when  I  would  take  long 
walks  in  the  country  where  I  learned  much  about  bird- 
life  which  has  been  a  great  comfort  and  help  to  me, 
though  in  later  years,  as  I  have  had  more  to  do,  I  have 
lost  much  of  my  knowledge,  my  interest  in  it.  I  felt 
that  I  should  employ  my  leisure  or  a  portion  of  it,  in 
the  study  of  my  profession,  but  the  thought  of  it  was 
so  repugnant  that  I  actually  accomplished  very  little. 

"On  the  several  occasions  when  my  father  went  away 
and  left  his  practice  on  my  hands,  I  suffered  horribly, 
but  I  accepted  the  situation,  because  it  seemed  to  be 
unavoidable.  It  was  my  fate.  The  thought  of  revolt 
never  seemed  to  have  occurred  to  me. 

"When  I  was  a  student  in  the  medical  school,  I  woke 
one  night  with  some  abdominal  pain,  not  particularly 
severe,  but  soon  I  began  to  shake  violently  so  that 
the  whole  bed  moved.  I  have  been  subject  to  such 
nervous  chills  ever  since.  Sometimes  they  come  at 
rather  frequent  intervals,  and  then  I  may  go  perhaps 
a  year  without  one.  Of  late  years,  I  am  often  ill  for 
a  day  or  two  after  them,  with  loss  of  appetite,  general 
malaise,  etc. 

"After  the  death  of  my  wife  and  after  I  had  resumed 
work  I  had  a  most  striking  psychological  experience, 
I  was  in  a  state  of  spiritual  exaltation. 

"I  had  the  kindest  feeling  for  everyone,  and  every- 
one seemed  to  feel  the  same  way  toward  me,  but  here 
is  the  remarkable  thing  about  it;  I  seemed  to  be  living 
two  distinct  lives  at  the    same  time.      One  was  the 


3IO     Causation  and  Treatment^  Psychopathic  Diseases 

ordinary  everyday  life  of  walking,  working,  eating,  and 
drinking,  and  the  other  a  higher,  serene  spiritual  life 
which  the  small  occurrences  of  the  other  life  did  not 
affect  in  the  least.  In  the  higher  spiritual  life  I  seemed 
to  be  very  near  my  dead  wife.  I  wrote  a  letter  to 
friends  at  the  time  describing  this  experience  and  after- 
wards tried  to  recover  the  letter,  but  it  had  unfortu- 
nately been  destroyed.  I  am  not  in  the  least  in  doubt 
about  the  two  states  in  which  I  lived  for  the  experience 
was  as  vivid  as  any  I  ever  had  in  the  material  world, 
but  the  thing  seemed  to  me  rather  unusual,  and  I 
thought  the  letter  might  throw  some  further  light  upon 
it.  How  long  this  state  of  exaltation  lasted  I  do  not 
know. 

*'I  gradually  built  up  a  little  practice,  confined  to  the 
eye  and  ear.  I  belonged  to  numberless  local  organiza- 
tions which  occupied  my  evenings. 

*'A11  this  time  I  was  much  depressed  and  worried. 
In  1908  I  felt  that  everything  that  I  did  in  a  business 
way  was  wrong,  that  I  never  was  able  to  satisfy 
a  patient,  and  that  I  was  losing  what  little  practice  I 
had.  I  remember  sitting  alone  in  my  office  one  after- 
noon, putting  my  head  down  in  my  arms  and  saying 
aloud,  'I  don't  deserve  it,  I  don't  deserve  it.'  About 
this  time  I  was  haunted  by  the  suicide  idea.  In  my 
terrible  mental  distress  this  one  idea  seemed  to  give  me 
relief — to  offer  a  solution.  When  I  went  to  bed  at 
night  at  this  time  I  would  hear  a  persistent,  rhythmical 
squeak  in  my  chest  which  kept  me  awake.  On  exam- 
ination by  a  specialist  this  proved  to  be  a  functional 
sound.  I  was  advised  to  stop  smoking  which  I  did, 
and  the  squeak  disappeared.  The  mental  condition 
also  improved. 

"I  took  up  my  work,  although  feeling  that  it  was 
impossible  for  me  to  do  it. 

"Each  morning,  with  the  exception  of  one,  I  woke 


Psychopathic  Fears  311 

very  early  and  suffered  mental  tortures.  Sometimes 
when  I  first  became  conscious  after  waking,  I  would  be 
comfortable,  but  sooner  or  later  the  distress  would  come. 
It  seemed  to  me  that  I  had  a  terrible  problem  to  solve, 
but  I  could  not  reach  a  satisfactory  conclusion.  The 
problem  concerned  my  success  in  life  and  earning  a 
livelihood,  and  failure  to  solve  it  meant  insanity.  I  felt 
that  I  must  do  something  radical,  start  out  in  some 
new  line  of  work,  like  public  welfare  work  or  possibly 
some  form  of  agriculture,  but  always  in  these  early 
morning  agonies  I  was  forced  back  upon  my  own 
special  work  as  the  only  practical  thing  and  a  horrible 
fear  seized  me,  I  realized  that  there  was  no  escape  from 
it. 

"At  these  times  I  would  shake  violently  with  fear, 
and  once  I  seemed  to  have  descended  into  the  very 
abyss  of  despair  where  it  would  be  impossible  to  live  for 
many  moments.  I  am  sure  that  I  should  have  rushed 
from  my  room  screaming,  if  the  fear  had  lasted.  Once, 
years  before,  after  great  emotional  excitement,  I  had 
had  a  similar  sensation,  but  not  as  pronounced.  I 
rose  each  morning  with  paralyzing  fear  gripping  me, 
and  mechanically  performed  my  duties  as  school  phy- 
sician. 

"After  a  time  I  told  my  father  of  my  condition,  but 
I  felt  that  I  could  not  make  him  understand  the  situa- 
tion in  which  I  found  myself.  One  morning  I  found 
relief  in  assuring  myself  that  I  would  keep  on  with  my 
work,  but  would  not  take  any  of  the  cases  which  I 
dreaded;  the  relief  was  only  temporary. 

"At  another  time,  after  a  talk  with  my  father  in  which 
he  talked  encouragingly  about  going  into  apple  raising, 
I  had  a  more  comfortable  night. 

"I  took  a  course  of  treatment,  dieting, drinking  Vichy 
and  taking  exercise  without  any  appreciable  effect. 
My  father  offered  to  stay  with  me,  on  account  of  my 


312     Causation  and   Treatment,  Psychopathic  Diseases 

terrible  loneliness  and  fears;  at  first  I  declined,  but 
later  accepted,  and  found  some  comfort  in  feeling  that 
he  was  near. 

"With  the  idea  that  I  must  do  something  to  save 
myself  from  losing  my  grip,  I  forced  myself  to  prepare 
for  operation,  but  perhaps  fortunately  for  the  patient, 
although  1  got  everything  in  readiness,  he  did  not 
appear. 

"Often,  especially  if  I  had  some  exercise  in  the 
morning  followed  by  a  bath,  I  would  feel  quite  normal 
in  the  afternoon  and  in  the  evening. 

"For  a  time  during  the  early  morning  distress  it 
seemed  as  though  there  was  some  solution  to  my 
problem,  but  after  a  time  I  could  not  tell  what  was  the 
cause  of  my  great  mental  distress  which  would  not 
allow  me  to  rest,  but  tortured  me  until  I  writhed  and 
groaned.  Then  the  fear  of  failure,  poverty,  destitution, 
and  disgrace,  seemed  to  take  possession  of  me,  and  I 
remember  one  morning,  before  my  father  was  sleeping 
with  me,  that  I  woke  him  and  got  him  to  assure  me  that 
he  thought  I  was  able  to  earn  my  own  living. 

"These  fears  which  came  up  in  my  business  and 
even  social  life,  would  take  possession  of  me  in  the  early 
morning  hours  and  torture  me  with  terror  and  horror. 
I  found  some  relief  in  talkng  these  matters  over  with 
my  father  and  step-mother  and  getting  their  advice. 

"Invariably,  when  I  felt  normal,  it  seemed  to  me 
that  I  ought  to  get  away  from  everything  and  get  some 
kind  of  work  that  would  give  me  plenty  of  exercise 
out  of  doors  and  freedom  from  mental  effort,  but  when 
the  fear  and  depression  gripped  me  again  it  all  seemed 
hopeless. 

"If,  when  I  returned  from  abroad  last  fall,  I  could 
only  have  found  someone  among  those  to  whom  I  con- 
fided my  troubles,  who  could  see  that  I  was  incapable 
of  doing  anything  for  myself,  and  taking  things  on  their 


Psychopathic  Fears  313 

own  hands,  have  sent  me  where  my  mind  could  have 
been  relieved  of  all  unnecessary  worries,  my  body 
supplied  with  plenty  of  wholesome  exercise  in  the  open 
air  and  abundance  of  good  food,  I  might  have  been 
saved  from  months  of  hideous  nightmares. " 

XVI 

"In  plain  English  I  am  'self-conscious.'  I  have 
this  self-consciousness  in  a  most  acute  form.  I  would 
be  classed  as  a  monomaniac  on  the  subject,  and,  silly 
as  it  may  seem,  it  is  ruining  my  whole  life. 

"I  don't  think  that  as  a  boy  I  was  diffident  or  bashful 
to  a  marked  degree.  This  self-consciousness  was  ac- 
quired and  grew  on  me.  Up  to  the  age  of  fourteen  I 
could  'speak'  at  school  and  do  the  other  things  that 
boys  of  that  age  do  without  embarrassment,  but  one 
day  at  about  that  age,  I  arose  to  recite.  I  got  a  little 
mixed  up  and  a  little  'rattled,'  when  I  sat  down  the  boy 
behind  me  commenced  to  'guy'  me,  told  me  how  red 
my  face  was,  etc.,  and  kept  it  up  for  some  time  and  it 
seemed  to  prey  on  my  mind.  The  next  day  when  I 
arose  to  recite  I  commenced  to  fear  lest  my  face  would 
get  red  again  and  the  first  thing  I  knew  my  face  was 
burning  and  my  voice  shaking.  From  that  time  on  I 
was  never  able  to  get  up  in  school  and  recite  without 
fearing  that  the  pupils  were  watching  me  to  see  how 
red  my  face  would  get  and  how  embarrassed  I  would 
look,  and  that  fear,  'imagining,'  did  the  work.  Finally 
out  of  pity  the  teachers  excused  me  from  speaking,  or 
I  should  say  attempting  to  speak  before  the  school  and 
reciting  before  the  class. 

"After  I  left  school  I  appeared  to  get  better  along 
that  line.  My  father  was  cashier  of  a  bank,  and  after 
taking  a  course  of  shorthand  at  a  business  college  I 
went  to  work  there.     All  this  time  I  was  always  self- 


314     Causation  and   Treatment,  Psychopathic  Diseases 

conscious  and  prone  to  blush,  but  the  newer  surround- 
ings made  it  easier  for  me  than  with  all  of  the  scholars 
who  knew  my  weakness. 

"During  the  last  few  years  the  fear  has  been  grow- 
ing on  me  again  and  in  some  respects  I  am  worse 
than  I  ever  was  before  in  my  life.  If  I  pass  a  friend 
on  the  street  who  knows  my  weakness,  I  at  once 
proceed  to  get  much  embarrassed  and  'red'.  I  fear 
that  he  is  watching  me  to  see  me  do  that  very  thing 
and  so  do  not  disappoint  him.  The  horror,  and  it  is 
a  horror,  with  me,  of  getting  red  in  the  face  is  with 
me  every  minute  that  I  am  awake.  The  confidence 
that  I  should  have  to  shake  it  off  I  do  not  seem 
able  to  get.  If  there  is  something  that  I  am  obliged 
to  do  that  will  bring  me  into  a  little  prominence,  such 
as  attending  a  dinner  (that  I  cannot  get  out  of)  I  will 
worry  for  days  for  fear  that  I  will  make  a  'fool  of 
myself,'  and  of  course,  this  previous  worrying  does  not 
help  to  put  me  in  good  shape  when  the  time  comes. 

"I  could  go  along  writing  several  pages,  but  I  think 
that  I  have  said  enough  to  enable  you  to  see  how  this 
'fear  hallucination'  has  a  hold  of  me.  I  am  sure  that 
I  am  not  of  a  retiring  disposition  naturally,  I  enjoy  the 
society  of  both  sexes.  I  can  go,  say  on  a  moonlight 
automobile  trip  and  be  just  as  natural  and  as  much  at 
ease  as  anyone,  but  to  sit  down  to  a  dinner,  commence 
to  imagine  that  the  people  are  glancing  at  me  to  see 
whether  I  am  getting  red  in  the  face  and  then,  as  the 
boy  says,  'the  stuff  is  off.' 

"There  was  one  thing  I  could  do,  I  always  took  an 
intense  interest  in  baseball  and  played  it  for  years.  On 
the  ball  field  I  had  absolute  confidence  in  myself,  and 
could  get  up  before  any  number  of  people  without  the 
least  bit  of  embarrassment  or  nervousness  in  the  tightest 
places.  In  fact,  once  when  our  team  was  playing  in 
another  town,  in  writing  up  the  game  the  next  day,  the 


Psychopathic  Fears  315 

editor  of  the  paper  stated  that  'Young  G.  has  the  nerve 
of  a  Von  Moltke;  he  never  gets  excited  or  rattled.'  Now 
if  I  can  get  some  of  the  confidence  that  I  had  on  the 
ball  field  in  my  business  and  social  relations  it  would 
mean  a  whole  lot  to  me,  otherwise  I  am  more  or  less  of  a 
failure.  Lately,  I  have  been  having  periods  of  depres- 
sion and  at  time  I  feel  that  I  would  almost  welcome 
anything  to  end  this  foolish  fear. 

"You  probably  think  that  I  am  lacking  in  will  power 
and  I  surely  am  in  this  one  respect  at  least,  but  I  have 
been  successful  in  a  business  way. 

"My  father  is  state  accountant  and  has  been  for  the 
past  five  years.  During  this  time  I  have  been  cashier 
in  reality,  although  I  wouldn't  accept  the  office  and 
name.  The  directors  have  voluntarily  raised  my 
salary  at  different  times,  and  I  know  that  my  business 
judgment  is  respected;  but  this  other  matter,  silly  as  it 
may  seem,  keeps  gnawing  at  my  nerves  and  I  feel  that 
some  of  these  days,  unless  I  am  able  to  shake  it  off, 
that  I  will  be  a  nervous  wreck  or  go  insane.  It  is  a.  fear 
hallucination^  pure  and  simple,  but  I  must  get  rid  of  it 
soon." 

XVII 

"From  my  earliest  recollections  I  was  an  unusually 
brave  child  and  proud  of  my  bravery.  Older  brothers, 
on  account  of  this,  tried  to  frighten  me  in  every  manner 
possible.  One  appeared  with  a  false  face  and  frightened 
me  so  that  I  have  ever  since  been  afraid  of  everything 
else.  Throwing  chickens  at  me  also  resulted  in  my 
being  afraid  of  all  feathered  animals  since.  Even  a 
bunch  of  feathers  gives  me  an  unhappy,  frightened 
feeling.  Being  bitten  several  times  by  dogs  has  made 
me  fearful  of  dogs,  and  contributed  to  my  general  ner- 
vousness. 


3i6     Causation  and  Treatment,  Psychopathic  Diseases 

"When  about  five  years  old  (the  year  I  received  my 
first'serious  fright)  I  snapped  a  rubber  in  my  left  eye, 
turning  the  pupil  in.  Children  teased  and  made  fun 
of  my  eye,  calling  me  'cross-eye,'  and  thus  made  me 
nervous,  sensitive,  and  uncomfortable  in  company. 
Also,  perhaps,  turned  my  thoughts  in  a  morbid,  self- 
conscious  channel,  to  which  other  incidents  have  con- 
tributed since  then. 

"I  did  not  go  to  school  until  I  was  eleven  years  old, 
on  account  of  my  sensitiveness  about  my  eye.  My 
mother,  also  of  my  disposition  as  to  sensitiveness, 
taught  me  at  home.  At  eleven,  I  was  operated  on,  the 
pupil  coming  back  into  its  proper  place.  Since  then,  I 
cannot  read  with  my  left  eye.  My  eyes  water  when 
out  of  doors,  and  I  can  with  difficulty  keep  them  open. 
When  embarrassed  or  annoyed  my  eyes  have  a  queer 
feeling  over  which  I  have  no  control.  It  makes  me  so 
uncomfortable  to  think  I  cannot  keep  my  eyes  from 
showing  my  inner  feelings  so  readily.  I  believe  it  is 
due  to  their  weakness.  My  right  eye,  with  which  I 
read  constantly,  has  for  the  last  few  months  felt  blurred. 

"My  grandmother  came  to  live  with  us  when  I  was 
about  seven  years  old,  and,  I  think,  ruined  all  our  dis- 
positions by  scolding,  nagging,  and  slapping  us  almost 
constantly.  We  could  not  do  the  slightest  thing,  stand 
still,  or  sit  down  without  a  scolding.  From  being  of  a 
sunny,  bright  disposition,  I  became  morose  and  sullen 
and  am  continually  looking  for  affronts  and  brooding 
over  them  and  have  developed  a  disposition  to  worry 
over  trifles  and  never  to  feel  certain  that  I  have  taken 
the  right  course  in  anything,  also  to  have  a  morbid 
sensitiveness  to  and  fear  of  the  opinion  of  others  and 
never  to  feel  happy  or  satisfied  in  any  place.  I  am 
always  looking  forward  to  next  year,  or  next  month,  or 
to  going  some  other  place,  where  things  will  be  more 
pleasant. 


Psychopathic  Fears  317 

"When  in  company,  I  never  seem  to  know  what  to 
say,  and  in  my  nervous  fear,  I  say  too  much  and 
afterwards  feel  an  agony  of  mortification  over  remarks 
that  I  regard  as  absurd.  From  this  fact,  I  think, 
I  have  very  few  friends.  My  peculiarities,  due  to  my 
nervousness,  all  of  which  I  am  acutely  conscious  and 
worry  on,  cause  me  to  be  alone  wherever  I  go.  I  try 
to  please  people  and  go  out  of  my  way  to  do  favors  for 
friends,  but  I  am  unpopular,  because  of  the  manner- 
isms and  self-consciousness  I  possess. 

"I  taught  school  six  years,  and  worked  faithfully 
early  and  late.  Being  accounted  a  good  disciplinarian, 
I  was  given  some  hard  rooms  to  teach  and  was  kept  in 
nervous  tension  all  the  time.  My  last  year  teaching 
was  begun  in  my  home  town,  and  I  was  given  a  room 
of  the  worst  children  in  town;  and,  being  sensitive  to 
the  opinions  of  my  home  people,  I  felt  hampered  to 
carry  out  as  strict  measures  of  discipline  as  were 
necessary;  but  for  the  same  reason  I  hated  to  give  it  u.p. 

"My  mother's  health  gave  out  and,  my  father's  work 
being  in  F.  that  year,  I  asked  for  leave  of  absence  and 
we  went  to  F.  in  January.  While  there  I  was  continual- 
ly worried  over  the  thought  of  my  return  to  school  and 
in  April  I  heard  a  friend  remark  that  I  was  growing 
hard  of  hearing,  and  when  I  reached  home  in  May,  a 
noise  in  my  ears  started  and  has  never  ceased.  Dr. 
Mayo  of  Rochester  treated  my  ears  and  cut  out  my 
tonsils  and  cauterized  my  nose  to  help  my  hearing,  but 
I  have  grown  steadily  worse.  This  was  in  1906.  The 
noise  in  my  ears  aggravates  my  nervousness.  My  voice 
seems  affected  so  that  people  have  difficulty  hearing  me. 
In  company  I  sometimes  dread  to  speak  at  all.  I  took 
up  shorthand  and  typewriting,  but  lost  two  positions  on 
account  of  my  deafness.  I  nearly  always  feel  tired  and 
lacking  in  energy,  due  to  my  nervous  fear  and  appre- 
hensive thought.     I  have  read  so  much  that  I  seem  to 


3i8     Causation  and  Treatment,   Psychopathic  Diseases 

exist  in  a  world  of  books  quite  apart  from  this  world  of 
reality,  and  am  only  contented  when  poring  over  a 
book. 

"As  a  child,  I  was  timid,  apprehensive,  full  of  fears. 
As  I  grew  older,  I  could  be  easily  made  angry  and 
seemed  to  lose  all  control  of  myself  when  angry.  I 
cannot  answer  anyone  who  affronts  me,  because  I  lose 
all  control  of  my  nerves,  eyes,  and  voice.  I  feel  para- 
lyzed with  fear  and  anger. " 

XVIII 

"From  childhood  I  have  always  been  extremely 
timid.  The  illness  and  death  of  my  youngest  and 
favorite  brother  seven  years  ago  was  a  particularly  dis- 
tressing one,  which  rendered  him  completely  helpless 
for  a  year  and  a  half,  during  which  time  I  dreamed  of 
his  death  or  some  scene  connected  with  his  illness  would 
occur.  For  a  year  after  his  death  I  scarcely  passed  a 
night  without  dreaming  of  him  nor  a  day  without  feel- 
ing the  loss,  so  constantly  had  we  been  together  and 
so  deep  were  my  love  and  admiration  for  this  witty, 
clever  brother  who  had  always  been  so  kind  and  con- 
siderate. 

'During  the  past  four  years  I  have  experienced 
several  peculiar  dreams.  The  last  of  them  was  last 
August  in  M.  when,  for  the  first  time  since  her  death  in 
January,  I  dreamed  of  my  mother.  She  looked  at  me 
pityingly  and  embraced  me,  holding  me  for  a  long  time 
as  though  to  give  comfort.  The  dream  was  very  real. 
The  following  day  a  letter  reached  me  from  a  friend  at 
home;  a  real  estate  dealer  saying  that  he  thought  he 
should  probably  be  able  to  make  a  sale  of  our  old  house 
to  the  man  he  had  had  up  to  look  at  it  the  preceding 
day.  Having  the  house  pass  into  other  hands  and  the 
prospect  of  my  having  to  leave  it  all  had  been  much 


Psychopathic  Fears  319 

on  her  mind  during  her  last  illness  of  which  my 
brother's  family  next  door  had  knowledge. 

"The  fall  preceding  mother's  death  I  had  been  away 
from  home  several  weeks  in  K.,  taking  treatment  for  my 
stammering.  Mother  became  aware  that  her  condition 
was  growing  serious  and  though  she  did  not  write  me 
at  all  differently  from  usual  and,  although  she  concealed 
her  condition  from  my  brothers  who  were  near  her,  I 
seemed  to  know  it  and  reluctantly  went  to  spend  a  short 
time  with  my  foster-sister,  as  my  mother  wrote  to  urge 
me  to  do,  during  the  whole  of  which  time  I  felt  appre- 
hensive about  my  mother,  and  I  began  to  stammer 
severely. 

"My  father's  illness  was  longer,  and  during  it,  upon 
our  physician's  advice  on  the  return  of  my  foster- 
sister  from  school  in  the  spring  the  family  persuaded  me 
to  go  away  for  awhile.  For  a  couple  of  weeks  I  en- 
joyed my  visit  when  all  at  once  with  so  far  as  I  could 
judge  nothing  in  the  letter  to  indicate  much  of  a  change 
in  his  condition,  I  became  apprehensive  and  felt  that  I 
must  return  at  once.  But  because  my  little  nephew 
was  to  return  with  me  and  the  journey  was  a  long  one 
and  each  day  his  pass  was  expected,  I  unwillingly 
waited  and  was  not  surprised  when  we  received  a  tele- 
gram saying  that  my  father  was  dead. 

"Last  June,  at  the  time  of  my  operation  at  M.,  I 
had  decided  hastily  and  did  not  think  it  wise  or  neces- 
sary to  inform  any  of  the  members  of  the  family.  I 
was  ill  with  the  shock  afterward  and  wished  very  much 
for  my  foster-sister,  but  she  was  too  far  away  to  be 
sent  for,  and  I  improved  so  rapidly  so  I  wrote  her  at 
the  usual  time  in  the  usual  way  without  mentioning  the 
operation.  Before  even  this  could  have  reached  her, 
I  received  a  letter  from  her,  saying  'what  is  the  matter,' 
'I  know  you  are  ill.' 

"Why  does  it  prove  a  strain  to  meet  strangers  and 


320     Causation  and  Treatment,  Psychopathic  Diseases 

to  be  with  people  for  long  at  a  time?  T  believe  one  of 
the  causes  to  be  the  great  amount  of  criticism  to  which 
I  was  subjected  in  childhood  both  before  guests  and 
after  their  departure,  and  to  be  with  people,  which 
made  a  very  deep  and  painful  impression  on  my  mind. 
My  little  girl  cousin  who  lived  with  us  was  extremely 
exacting,  and,  while  there  was  really  a  warm  affection 
between  us,  there  were  constant  differences  and  con- 
stant irritation,  and  unless  my  brothers  interfered,  if 
there  was  harmony  it  was  only  secured  by  my  giving 
way  to  her.  Of  course,  I  was  not  blameless  in  the 
matter,  being  unduly  sensitive,  often  teasing  and  dis- 
liking a  fuss  above  all  things  and  never  being  strong. 
"Until  the  last  years  of  his  life  my  father  used  to,  at 
long  intervals,  indulge  in  fits  of  drinking  in  which  he 
became  violent,  and  I  have  often  seen  him  take  a  knife 
and  threaten  to  kill  my  brothers  when  they  kept  him 
from  going  out  for  more  liquor,  and  they  would  have  to 
hold  him  and  soothe  him.  The  fear  of  disgrace,  the 
horror  of  it,  and  my  mother's  grief,  made  a  deep  impres- 
sion. We  never  spoke  of  it,  of  course,  to  outsiders, 
and  seldom  in  the  family  except  when  we  would  become 
apprehensive  that  he  was  starting  to  drink." 

XIX 

"I  am  a  married  woman  of  iifty-two.  All  my  life  I 
have  been  imprisoned  in  the  dungeon  keep  of  fear. 
Fear  paralyzes  me  in  every  effort.  If  I  could  once 
overcome  my  enemy,  I  would  rejoice  forever  more. 

' 'In  childhood  everything  cowered  me.  I  was  bred  in 
fear.  At  five  or  six  my  mother  died,  and  I  feared  and 
distrusted  a  God  who  would  so  intimidate  me  and  be- 
reave me.  I  heard  tales  of  burglars,  being  discovered 
in  hiding  under  beds,  and  a  terrified  child  retired  nightly 
for  years.     I  was  in  agony  of  fear.     My  fears  I  never 


Psychopathic  Fears  321 

told.  Later  I  heard  of  the  doctrine  of  God's  fore- 
knowledge, and,  as  a  little  rebel,  I  would  place  dishes 
on  the  pantry  shelves,  changing  from  place  to  place, 
and  then  giving  up  In  despair,  knowing  that  if  fore- 
knowledge were  true,  God  knew  that  I  would  go 
through  with  all  that  performance. 

"Through  childhood  I  feared  suicide.  It  was  a  world 
of  escape  that  appealed  to  me  and  yet  appalled  me.  I 
also  heard  of  somnambulism,  and  I  never  saw  a  keen 
bladed  knife,  but  I  dreaded  that  in  my  sleep  I  might  do 
damage  to  myself  or  to  my  friends  in  a  state  of  uncon- 
sciousness. 

"In  my  twenties  I  did  attempt  suicide  a  number  of 
times,  but  somehow  they  proved  unsuccessful.  I 
always  aimed  to  have  it  appear  an  accident.  I  dreaded 
to  have  my  death  appear  as  a  stain  and  disgrace  to  my- 
family  which  I  loved. 

"I  always  fear  to  walk  at  any  height,  on  a  trestle 
over  running  walls,  or  even  to  walk  on  a  bridge  without 
side  railings. 

"As  a  child  I  was  afraid  of  the  dark,  I  was  afraid  of 
going  out  on  the  street  in  a  dark  night.  In  fact,  even 
a  moonlight  night  terrified  me  when  I  remained  alone. 
I  was  afraid  to  go  into  dark  places,  such  as  cellars,  or 
into  lonely  places  even  in  the  day  time. 

"As  a  child  I  was  always  shy,  fearful,  timid  and  self- 
conscious  to  a  painful  degree.  Even  as  a  grown-up 
woman  I  am  often  a  sufferer  from  the  same  cause,  al- 
though I  have  sufficient  self-control  to  conceal  it. 

"I  have  to  be  careful  of  my  state  of  health,  as  the 
latter  is  very  delicate.  I  am  a  chronic  sufferer  from 
indigestion  and  constipation,  although  I  somehow 
manage  to  regulate  these  troubles. 

"When  I  need  my  nerves  in  good  control  so  fre- 
quently, they  are  in  a  state  of  utter  collapse.  My 
brain  is  in  a  state  of  confusion,  in  a    state    of    whirl 


322     Causation  and  Treatment^  Psychopathic  Diseases 

just  when  I  need  to  think  the  clearest.  My  poor  brain 
feels  as  if  a  tight  band  encircled  and  contracted  it.  It 
seems  to  me,  as  if  the  brain  has  shrunken  from  the 
temples. 

"My  memory  is  unreliable.  Often  I  read  quite 
carefully,  but  I  am  unable  to  recall  what  I  have  read. 
Especially  is  this  so,  if  called  upon  without  previous 
warning.  My  brain  goes  into  a  panic  of  an  extremely 
alarming  kind. 

"I  was  told  that  I  was  a  woman  of  a  good  brain  and 
of  great  talent,  that  all  I  needed  was  to  exercise  my  will 
and  determination,  and  that  I  would  succeed.  I  lack 
concentration  and  I  lack  confidence. 

"In  my  childhood  hell  fire  was  preached.  Fire  ordi- 
nation and  an  arbitrary  God  were  held  up  to  my  child- 
ish comprehension.  I  was  bred  in  fear,  and  self- 
destruction  resulted." 

XX 

The  following  valuable  account  given  me  by  an 
eminent  physician  brings  out  well  the  main  factors, 
laws,  and  principles  of  Psychopathology  expounded  in 
this  volume: 

"You  asked  me  to  write  about  my  fears.  I  give  you 
a  brief  account. 

"As  a  child,  as  far  as  memory  carries,  I  had  a  fear  of 
darkness,  fear  of  ghosts,  of  giants,  of  monsters,  and  of 
all  kinds  of  mysterious  and  diabolical  agencies  and 
witchcraft  of  which  I  have  heard  a  number  of  tales  and 
stories  in  my  early  childhood.  I  was  afraid  of  thieves, 
of  robbers,  and  of  all  forms  of  evil  agencies.  The  fears 
were  strong  at  daytime,  but  more  so  at  night.  Strange 
noises,  unexpected  voices  and  sounds  made  a  cold  shiver 
run  down  my  back. 


Psychopathic  Fears  323 

"I  was  afraid  of  remaining  alone  in  a  closed  room, 
or  in  the  dark,  or  in  a  strange  place.  It  seemed  to  me 
as  if  I  was  left  and  abandoned  by  everybody,  and  that 
something  awful  was  going  to  happen  to  me.  When  I 
happened  to  be  left  alone  under  such  conditions  I  was 
often  in  a  state  of  helplessness,  paralyzing  terror.  Such 
states  of  fear  sweep  occasionally  over  me  even  at 
present.  I  find,  however,  that  they  are  far  more  com- 
plicated with  associations  of  a  more  developed  personal 
life.  I  know  that  in  some  form  or  other  the  fears  are 
present,  but  are  inhibited  by  counteracting  impulses 
and  associations.  I  still  may  feel  a  cold  shiver  running 
down  my  back,  when  I  happen  to  go  into  a  dark  cellar 
in  the  dead  of  night,  or  happen  to  remain  alone  in  a 
dark,  empty  house.  Such  fears  date  back  to  my 
fourth  year,  and  possibly  to  an  earlier  time  of  my  child- 
hood. 

"As  a  matter  of  contrast-inhibitions  of  such  fears  I 
may  either  brace  myself  and  put  myself  in  a  state  of 
courage  and  exaltation,  or  when  this  does  not  succeed, 
I  let  my  mind  dwell  on  other  fears  and  troubles.  I  find 
that  the  last  method  is  often  by  far  the  more  effective 
in  the  inhibition  of  fear  states  which  at  the  moment  are 
present  with  me.  All  I  need  is  to  press  the  button,  so 
to  say,  and  awaken  some  other  fears,  the  present  fears 
diminish  in  intensity  and  fade  away  for  the  time  being. 
I  actually  favor  and  welcome  and  even  look  for  disagree- 
able and  painful  experience  so  as  to  overcome  some  of 
my  present  fears.  The  new  fears  are  then  treated  in 
the  same  way. 

"As  I  became  older,  about  the  age  of  eight,  I  began  to 
fear  disease  and  death.  This  may  be  due  to  the 
infectious  diseases  that  attacked  many  members  of 
our  family  when  I  was  about  the  age  of  eight.  In 
fact,  I  have  been  present  at  the  death  bed  of  some  of 
them,  and  the  impression  was  one  of  terror,  mysterious 


324     Causation  and   Treatment^  Psychopathic  Diseases 

horror.  I  was  afraid  I  might  get  diseases  from  which  I 
might  die.  After  my  witnessing  the  last  agonizing  mo- 
ments of  death,  my  elders  thought  of  removing  me  to  a 
safer  place;  their  fears  and  precautions  still  more  im- 
pressed the  fear  of  danger  of  disease  and  death.  I  may 
say  that  I  really  never  freed  myself  from  the  fear  of  dis- 
ease and  death.  The  latter  fears  are  always  present 
with  me  in  a  vague,  subconscious  form,  always  ready  to 
crop  up  at  the  least  favorable  opportunity.  This  fear, 
in  so  far  as  it  is  extending  its  tentacles  in  various  direc- 
tions, is  often  the  bane  of  my  life.  Even  at  my  best 
there  is  always  a  kind  of  vague  fear  of  possible  danger, 
lurking  unknowingly  to  me  in  various  objects  which 
may  be  infected,  or  possibly  poisonous. 

"This  fear  has  been  spreading  and  has  become  quite 
extensive,  involving  my  family,  my  children,  my 
friends,  my  acquaintances,  and  my  patients.  Usually 
I  ignore  these  fears,  or  get  control  over  them  by  an 
effort  of  will.  When,  however,  I  happen  to  be  fatigued, 
or  worried  over  small  things  by  the  course  of  my  work, 
or  happen  to  be  in  low  spirits  by  petty  reversals  of  life, 
these  fears  may  become  aroused,  as  if  from  slumber, 
and  may  come  forth  in  their  pristine  vigor.  Under 
such  conditions  I  may  become  afraid,  for  instance,  of 
drinking  milk,  because  it  may  be  tuberculous. 

"This  fear  may  spread  and  involve  fear  for  my 
children  and  my  patients;  or  again  I  may  be  afraid  of 
eating  oysters  and  other  shell  fish,  because  they  may  be 
infected  with  typhoid  fever  germs.  I  may  refuse  to 
eat  mushrooms,  because  of  the  possibility  that  they  are 
poisonous.  The  other  day  I  was  actually  taken  sick 
with  nausea  and  with  disposition  to  vomiting  after 
eating  of  otherwise  good  mushrooms.  The  fear  seized 
on  me  that  they  all  might  be  poisonous  'toadstools.' 
Such  fears  may  extend  to  ever  new  objects  and  persons. 
The  spreading  of  the  fears  to  ever  new  relations  and  to 


Psychopathic  Fears  325 

ever  new  associations  is  possibly  the  worst  feature  of 
the  trouble. 

"I  have  a  fear  of  coming  in  contact  with  strangers, 
lest  I  get  infected  by  them,  giving  me  tuberculosis, 
influenza,  scarlet  fever,  and  so  on.  This  mysophobia 
involves  my  children  and  my  friends,  inasmuch  that 
I  am  afraid  that  strangers  may  communicate  some 
contagious  diseases.  A  similar  fear  I  have  in  regard  to 
animals, — they  may  possibly  be  infected  with  rabies, 
or  with  glanders,  or  with  som^e  other  deadly,  pathogenic 
micro-organism.  I  am  afraid  of  mosquito  bites,  lest 
they  give  malaria,  or  yellow  fever.  The  fears,  in  the 
course  of  their  extension,  may  become  even  more  in- 
tense and  more  insidious  than  the  original  states. 

"About  the  age  of  fourteen  I  began  to  be  obsessed 
with  sexual  fears.  Advice  was  given  me  again  and 
again  that  all  sexual  acts  and  sexual  errors  make  boys 
sick  and  finally  result  in  a  lingering,  terrible  death. 
Such  advices  often  threw  me  into  a  panic,  on  account 
of  the  fears  I  already  had.  The  fears  grew  in  strength 
and  complexity.  I  was  often  seized  with  terror  over 
the  least  imaginable  sexual  trouble,  thinking  that  I  was 
to  become  a  wreck,  and  that  I  was  surely  going  to  die  a 
miserable  death.  Occasionally  I  was  seized  with  the 
fear  that  my  brain  might  give  way,  and  that  I  would 
die  in  agonies,  a  miserable  dement. 

"I  have  also  a  fear  of  dogs.  As  a  child  I  had  some 
bad  experiences  with  dogs.  I  was  attacked  by  dogs 
and  was  badly  bitten.  Although  this  fear  is  no  longer 
so  intense  as  it  was  in  my  childhood,  stilhl  know  it 
is  present.  My  heart  sometimes  comes  to  a  sudden 
standstill,  when  I  happen  to  come  on  a  strange  dog. 
When  the  strange  dog  growls  and  barks,  all  my  courage 
is  lost,  and  I  beat  an  inglorious  retreat.  It  is  only  in 
the  presence  of  other  people  that  I  can  rise  to  the  effort 
to  walk  along  and  apparently  pay  no  attention  to  the 


326     Causation  and   Treatment,  Psychopathic  Diseases 

dog.  This  is  because  I  fear  the  opinion  of  others  more 
even  than  I  fear  growls  of  dogs.  My  social  and  moral 
fears  are  far  greater  than  my  purely  physical  fears. 
Fear  has  invaded  my  mental  and  physical  organization. 

"When  I  became  older,  about  the  age  of  eighteen  to 
twenty,  a  new  form  of  fear  appeared,  like  a  new  sprout 
added  to  the  main  trunk  or  possibly  growing  out  of  the 
main  fear  of  disease  and  death,  that  is  the  fear  of  some 
vague,  impending  evil.  The  fear  of  some  terrible  acci- 
dent to  myself  and  more  so  to  my  family  or  to  any  of 
the  people  of  whom  I  happen  to  take  care  is  constantly 
present  in  the  margin  of  my  consciousness,  or  as  you 
would  put  it,  in  my  subconsciousness.  Sometimes  the 
fears  leave  me  for  awhile,  sometimes  they  are  very  mild, 
and  sometimes  again  they  flare  up  with  an  intensity 
that  is  truly  alarming  and  uncontrollable.  The  energy 
with  which  those  fears  become  insistent  in  conscious- 
ness and  the  motor  excitement  to  which  they  give  rise 
is  really  extraordinary.  The  fears  come  like  sudden 
floods.  The  energy  with  which  those  fears  rise  to 
consciousness  Is  often  overwhelming. 

"Fears  get  possession  of  me  under  circumstances  in 
which  my  suspicions  are,  for  some  reason  or  other, 
aroused  to  activity,  all  the  more  so  if  the  suspicions  of 
possible  impending  evil  are  awakened  suddenly.  In 
other  words,  the  fears  arise  with  the  stimulations  of 
associations  of  threatening  danger  to  myself  and  to  my 
family.  I  am  afraid  that  something  may  happen  to 
my  children;  I  fear  that  they  may  fall  sick  suddenly; 
I  fear  that  some  terrible  accident  may  happen  to  them; 
I  fear  they  may  fall  down  from  some  high  place  and  be 
maimed  or  be  killed.  I  fear  that  my  children  and  other 
members  of  my  family  may  be  poisoned  by  people  who 
are  not  well  disposed  towards  them.  I  am  afraid  that 
they  may  pick  up  food  that  was  infected,  or  that  they 
may  be  infected  in  school  by  children  who  happen  to 


Psychopathic  Fears  327 

suffer  from  some  infectious  maladies.  I  am  afraid  that 
my  children  may  be  overrun  by  some  vehicles,  by  auto- 
mobiles, or  that  they  may  be  killed  in  an  accident,  that 
they  may  be  killed  by  the  street  car,  or  even  that  the 
house  may  collapse.  This  latter  event  has  actually 
taken  place  when  I  was  a  child.  In  fact  many,  if  not 
all  of  those  fears  have  actually  their  origin  in  my  experi- 
ence. 

"As  I  write  to  you  these  lines  many  a  memory  of  such 
events  come  crowding  upon  my  mind.  Are  they  the 
noxious  seeds  that  have  been  planted  on  the  soil  oi 
fear.^  I  am  afraid  sometimes  that  even  the  food  I  and 
my  children  as  well  as  other  people  eat  may  give  rise 
to  toxic  products  and  thus  produce  disease.  Often  in 
the  dead  of  night  I  may  come  to  my  child  in  order  to 
convince  myself  that  he  has  no  fever  and  that  he  is  not 
threatened  by  any  terrible  disease.  The  very  words 
'sickness,'  'disease,'  'not  feeling  well,'  'death,'  arouse 
my  fears  and  sometimes  throw  me  into  a  panic.  I  am 
afraid  to  use  such  words  in  connection  with  any  of  my 
children.  I  am  afraid  the  evil  mentioned  may  actually 
happen. 

"As  a  child  I  learned  about  testing  and  omens.  If 
such  and  such  a  test  will  come  through  in  a  certain  way, 
it  is  an  omen  of  good  luck,  otherwise  it  means  bad  luck. 
This  superstitious  testing  and  omens  have  remained 
with  me,  and  that  in  spite  of  my  liberal  training  and 
knowledge  of  such  absurd  superstitions.  I  may  test 
by  opening  the  Bible  at  any  page,  or  I  may  test  by 
anything  that  might  occur  according  to  my  guesses. 
All  of  those  fears  I  know  have  no  meaning  for  me,  they 
are  senseless  and  absurd,  but  they  are  so  rooted  in  my 
early  childhood,  they  have  been  so  often  repeated, 
they  have  accumulated  round  them  so  much  emotion 
of  fear  that  they  come  to  my  mind  with  a  force  which 
is  truly  irresistible.     Many  of  the  fears  have  multiplied 


328     Causation  and   Treatment,  Psychopathic  Diseases 

to  such  an  extent  that  I  cannot  touch  anything  without 
arousing  some  slumbering  fear.  On  the  other  hand,  I 
am  enabled  to  play  one  fear  against  another  and  some 
times  obtain  counteracting  contrast  effects. 

"To  continue  with  my  fears.  I  am  often  afraid  that 
the  doors  are  not  well  locked,  and  I  must  try  them  over 
and  over  again.  I  go  away  and  come  again,  and  try  and 
try  again,  and  once  more.  It  is  tiresome,  but  as  the 
fear  is  constantly  with  me  and  is  born  again  and  again, 
I  cannot  be  satisfied,  and  must  repeat  the  whole  process 
over  and  over  until  I  get  tired,  and  give  up  the  whole 
affair  in  sheer  despair.  In  such  cases  a  contrary  and 
different  fear  comes  in  handy.  One  devil  banishes 
another.  I  am  afraid  that  the  gas  jet  is  left  open,  and 
I  must  try  it  over  and  over,  and  test  the  jets  with 
matches.  This  process  of  testing  may  go  on  endlessly 
without  assurance, — the  fear  remains  and  the  process 
must  begin  again  until  it  is  stopped  by  sheer  effort  of 
will  as  something  meaningless,  automatic,  and  absurd. 
The  performance  must  be  stopped  and  substituted  by 
something  else. 

"Colds  or  attacks  of  influenza  of  the  mildest  charac- 
ter have  given  rise  to  fears  of  pneumonia.  Pains  in  the 
abdomen  or  a  little  intestinal  distress  have  awakened 
fears  of  possible  appendicitis,  or  of  tumor,  or  of  in- 
testinal obstruction.  The  least  suspicion  of  blood  in 
the  stools  awakens  the  fear  of  possible  cancer.  Vomit- 
ing or  even  nausea  brings  fears  of  cancer  of  the  stomach. 
There  is  no  disease  from  which  I  have  not  suffered. 
The  only  diseases  I  have  not  feared  were  female  dis- 
eases. 

"The  same  fears  have  naturally  been  extended  to 
my  children  and  to  all  those  who  are  under  my  care. 
The  least  symptom  Is  sufficient  to  arouse  in  m^e  fears 
of  possible  terrible  and  horrible  consequences. 


Psychopathic  Fears  329 

"I  am  afraid  that  suits  may  be  brought  against  me, 
or  that  some  of  my  own  people,  patients  and  even 
employees  whom  I  discharge  may  bring  legal  action 
against  me  in  court,  or  blackmail  me.  When  I  leave 
home,  I  am  afraid  that  something  terrible  has  hap- 
pened. The  fear  of  impending  evil  is  always  with  me. 
The  fears  have  invaded  every  part  of  my  being.  It 
seems  as  if  there  is  no  resistance  in  my  mind  to  those 
terrible  fear  states. 

"Perhaps  it  may  interest  you  to  know  that,  although 
I  am  quite  liberal  and  am  even  regarded  as  irreligious, 
still  I  am  afraid  to  express  any  bad  word  against  God, 
Christ,  saints,  martyrs  of  any  church  and  denomination, 
be  they  Christian,  Mohammedan,  Buddhist  and  even 
pagan  such  as  Apollo  or  Zeus  or  Jupiter  or  Ahriman 
and  Ormuzd.  I  am  afraid  lest  they  may  hear  me  and 
do  me  harm.  I  fear  to  say  a  bad  word  even  about  the 
devil  and  Satan.  I  am  obsessed  by  fears.  Fears  pursue 
me  as  long  as  I  am  awake,  and  they  do  not  leave  me 
alone  in  my  sleep  and  dreams.  Fears  are  the  curse  of 
my  life.  And  yet  I  have  control  of  them,  none  but 
you  has  any  suspicion  of  them.  I  go  about  my  work  in 
a  seemingly  cheerful  and  happy  way.  The  fears,  how- 
ever, are  the  bane  of  my  life,  and  torture  me  by  their 
continued  presence. 

"I  tried  to  find  whether  or  no  those  fears  had  any 
relations  to  my  wishes  or  to  my  sexual  experiences.  I 
must  say  that  I  find  that  they  bear  no  relation  what- 
ever to  wish  or  sex.  My  mental  states  grow  on  fear, 
take  their  origin  in  fear,  and  feed  on  fear.  Fear  is  the 
seed  and  the  soil  of  all  those  infinite  individual  phobias 
that  keep  on  torturing  me  without  mercy,  phobias 
which  I  must  control  by  a  supreme  effort  of  will. 

"Truly  the  Biblical  curse  well  applies  to  my  life: 

"'The  Lord  will  make  thy  plagues  wonderful,  and  the 
plagues  of  thy  seed,  even  great  plagues,  and  of  long 


330     Causation  and   Treatment^  Psychopathic  Diseases 

continuance,  and  sore  sickness,  and  of  long  continu- 
ance. Moreover,  he  will  bring  upon  thee  all  the  dis- 
eases of  Egypt,  which  thou  wast  afraid  of;  and  they 
shall  cleave  unto  thee.  And  every  sickness,  and  every 
plague,  which  is  not  written  in  the  book  of  this 
law,  them  will  the  Lord  bring  upon  thee,  until  thou  be 
destroyed.  Thou  shalt  find  no  ease,  neither 
shall  the  sole  of  thy  foot  have  rest;  but  the  Lord  shall 
give  thee  a  trembling  heart,  and  failing  of  eyes,  and 
sorrow  of  mind.  And  thy  life  shall  hang  in  doubt 
before  thee;  and  thou  shalt  fear  day  and  night,  and 
shalt  have  none  assurance  of  thy  life.  In  the  morning 
thou  shalt  say.  Would  God  it  were  even!  and  at  even 
thou  shalt  say.  Would  God  it  were  morning!  for  the 
fear  of  thine  heart  wherewith  thou  shalt  fear  .  .  . ' 
"I  laid  bare  my  soul  before  you.  I  permit  you  to  do 
with  this  document  whatever  you  may  think  fit. " 

In  all  these  various  cases  and  accounts  we  find  the 
pathological  background  the  impulse  of  self-preserva- 
tion with  the  fear  instinct  highly  intensified,  invading 
more  and  more  the  life  of  the  individual  while  the 
available  fund  of  his  dynamic  energy  keeps  on  falling. 
At  the  same  time  we  can  observe  clearly  the  main 
psychopathological  principles,  formulated  above,  in 
the  evolution  of  psychopathic  mental  aggregates. 

Most  of  these  patients  were  cured  by  hypnoidal, 
twilight  treatment,  by  disintegration  of  the  fear 
systems,  both  in  the  waking,  and  hypnoidal  states,  also 
by  a  healthy  life  of  work  and  by  an  improved  condi- 
tion of  metabolism.  About  seventy-five  per  cent  re- 
mained in  good  condition,  and  could  be  regarded  as 
having  been  permanently  cured.  Out  of  the  twenty- 
five  per  cent  left  about  twenty  per  cent  improved  in 
their  mental  condition,  and  five  per  cent  did  not 
respond,  on  account  of  the  short  time  of  treatment. 


Psychopathic  Fears  331 

The  course  of  treatment  of  psychopathic  cases  aver- 
ages from  half  a  year  to  a  year  and  a  half.  In  severe 
cases  the  course  of  treatment  may  take  two  to  three 
years.  Patience  and  perseverance  are  requisite  in  the 
treatment  of  each  and  every  psychopathic  case. 

On  the  whole,  psychoneurotic  cases  are  easier  to 
handle  than  psychosomatic  cases,  but  somatopsychosis 
yields  more  rapidly  to  treatment,  especially  in  young 
persons,  than  do  cases  of  psychoneurosis.  As  a  rule 
men  are  easier  to  treat  than  women. 


CHAPTER  XVII 

GENERAL   PSYCHOTHERAPEUTIC   METHODS 

THE  overcoming  of  the  exaggerated  patho- 
logical state  of  the  impulse  of  self-preservation 
and  of  the  unduly  developed  fear  instinct  with 
all  the  accompanying  associations  is  the  object 
of  a  rational  Psychotherapy.  This  is  done  by  studying 
closely  the  patient's  history,  the  development  of  the 
case  from  early  childhood,  by  learning  the  various  fears 
that  have  grown  up,  and  have  become  formed  round 
the  nucleus  of  personality.  Everything  in  the  patient's 
life  should  be  studied  closely,  sympathetically,  without 
condemnation  and  blame.  The  patient's  views  of  life 
should  be  well  looked  into,  and  the  defects  and  mal-ad- 
justments  put  in  such  a  light  that  the  patient  should 
realize  where  the  faults  and  shortcomings  lie.  The 
matter  may  be  put  before  him  in  an  indirect  way  of 
research,  but  the  patient  himself  is  to  assimilate  the 
material,  laid  before  him;  he  is  to  work  the  matter  into 
the  spirit  of  his  personal  life.  Our  help  should  rather 
be  that  of  the  guide,  should  be  indirect,  and  should 
only  be  open  when  the  patient  realizes  the  importance 
of  our  aid,  and  asks  for  it  himself.  Of  course,  there  are 
cases  where  it  is  requisite  to  put  the  findings  before  the 
patient  directly,  fairly,  and  squarely.  This  is  a  matter 
of  the  physician's  judgment,  and  no  cut  and  dried  rule 
can  be  laid  down  in  such  cases. 

We  must  help  the  patient  straighten  out  his  warped 
personality.  The  exaggerated  pathological  state  of  the 
impulse  of  self-preservation  should  be  moderated,  the 
fears  should  be  eased,  controlled  gradually,  and  com- 
pletely annulled.     The  patient  should  not  be  left  to 

332 


General    Psychotherapeutic    Methods        333 

himself,  he  should  not  be  abandoned  to  the  chance  in- 
fluence of  other  people  while  under  treatment.  He 
should  feel  that  he  has  the  physician  with  him,  that  in 
case  of  need  he  has  a  man  on  whom  he  can  absolutely 
rely  for  help,  a  man  who  understands  him,  who  is  always 
willing  to  help  him,  and  deliver  him  from  all  scares  and 
fears. 

Light  cases  of  psychoneurosis  or  of  somatopsychosis 
may  be  treated  in  the  office  for  a  few  minutes  or  for 
half  an  hour  twice  or  three  times  a  week.  In  severe 
cases,  however,  the  patient  should  be  constantly  under 
the  physician's  care  until  he  is  delivered  from  the 
worries  of  his  fears  and  from  the  obsessions  of  his 
pathological  impulse  of  self-preservation.  The  work  of 
reconstruction  must  be  not  only  persistent  and  system- 
atic, but  must  also  be  carried  on  incessantly  and  unre- 
mittingly. 

Mental  anabolism,  the  construction  of  personality, 
is  the  object  of  therapeutic  work  in  psychopathic  mala- 
dies. The  psychopathic  malady  being  essentially  a 
disease  of  personality  in  various  stages  and  degrees, 
the  cure  is  the  gradual  modification  of  the  pathological 
state  of  the  affected  mental  systems,  conscious  and  sub- 
conscious. The  subconscious  systems  predominate  in 
the  total  aspect  of  the  psychopathic  symptom  complex. 
That  is  why  it  is  requisite  to  go  into  the  subconscious 
workings  of  the  mind  and  to  inform  oneself  of  the  early 
experiences  of  the  patient's  as  well  as  to  observe  closely 
the  patient's  habits,  dispositions,  character,  mental  and 
moral,  his  views  of  life,  his  actions,  and  be  specially 
informed  of  the  environment  under  which  the  disease 
had  its  origin,  or  of  the  psychogenesis  of  the  affection, 
and  of  the  further  conditions  under  which  the  malady 
kept  on  growing  and  developing.  The  present  environ- 
ment under  which  the  patient  lives,  the  mode  of  activity 
and  occupation,  the  duties  and  the  responsibility  of  life, 


334     Causation  and  Treatment,  Psychopathic  Diseases 

and  the  various  relations,  family,  social,  economical, 
political,  religious,  and  ethical,  should  all  be  taken  into 
consideration  and  closely  considered  in  the  treatment 
of  the  case.  In  short,  the  patient's  mental  life  should 
be  subject  to  a  thorough  searching  study,  the  case 
should  be  looked  at  from  all  standpoints. 

The  physical  condition  should  not,  however,  be  neg- 
lected, because  quite  often,  as  it  is  in  some 
psychopathic  cases,  the  physical  symptoms  form  nuclei 
round  which  the  psychopathic  affections  and  manifesta- 
tions become  organized  in  clusters  of  symptoms.  This 
is  especially  the  case  with  psychosomatic  patients. 
The  physician  should,  therefore,  devote  time  to  that 
side  of  the  patient's  life.  The  cardiac,  the  circulatory, 
digestive,  and  urinary  systems  should  be  examined  and 
attended  to. 

The  Method  of  Metathesis  and  of  Emotional  Antagonism 
is  often  consciously  or  unconsciously  employed  by  psy- 
chopathic patients.  When  a  fear  becomes  annoying, 
troublesome,  and  uncontrollable  the  patient  calls  up  some 
other  fear  replacing  the  present  fear  which  has  occupied 
the  field  of  attention.  This  forms  a  relief  to  the  patient. 
This  process  often  helps  in  the  spreading  of  the  psycho- 
pathic state  to  other  mental  systems.  Temporarily,  how- 
ever, there  is  some  relief.  Many  a  patientwho  has  learned 
the  value  of  this  method  employs  it  as  a  subterfuge 
to  escape  the  terrors  of  facing  his  fear  systems.  The 
study  of  the  fear  systems,  the  discussion  of  the  various 
aspects  of  the  fears  in  their  origin  and  development 
helps  both  to  face  the  fears,  and  at  the  same  time 
brings  about  a  transference  of  emotional  fear  agitation. 
This  helps  to  moderate  the  fears  by  bringing  about 
mutual  antagonistic  reactions.  One  fear  may  be  skil- 
fully played  towards  the  neutralization  of  others.  The 
patient,  however,  should  be  unaware  of  it.  The  neu- 
tralization of  pathological  systems  by  antagonistic  fear 


General  Psychotherapeutic  Methods  335 

systems  is  Important,  but  the  method  is  dangerous  and 
should  only  be  employed  after  careful  consideration  of 
each  step  so  as  to  get  effects  of  interference  and  Inhibi- 
tion and  not  effects  of  increase  and  superposition  of 
morbid  emotion.  Each  case  should  be  treated  on 
its  own  individual  merits.  There  are  no  cut  and 
dried  rules  in  Psychotherapy.  The  work  with  this 
method  requires  a  good  deal  of  tact,  foresight,  and  In- 
sight into  the  personal  character  of  each  patient.  What 
may  be  effective  with  one  patient  may  turn  out  a 
failure  with  another. 

The  synthesis  of  dissociated  systems  and  the  trans- 
formation of  the  patient's  personality  should  be  brought 
about  by  a  slow  and  gradual  process  of  system  modifica- 
tion. New  experience,  new  knowledge  and  activity, 
mental  and  moral,  should  be  cultivated.  The  new 
material  acquired  and  assimilated  into  the  patient's 
personal  life,  as  well  as  the  new  ways  of  thinking  and 
acting  help  In  the  modification  of  the  various  systems 
which  form  the  nucleus  of  the  psychopathic  state. 
The  modification,  although  performed  gradually,  may 
in  the  long  run  amount  to  a  complete  metamorphosis 
of  the  patient's  states,  and  thus  bring  about  a  complete 
synthesis  and  transformation  of  the  morbid  mental  and 
emotional  systems,  both  conscious  and  sub-conscious. 
The  enlargement  of  the  patient's  mental  horizon  and 
activity  Is  Indispensable  to  a  permanent  cure.  This, 
however,  from  the  very  nature  of  the  work,  must  be 
effected  slowly  and  gradually. 

♦  The  Method  of  Disintegration  Is  of  Import  in  Psycho- 
therapy. The  disintegration  may  be  brought  about  by 
associating  various  aspects  of  the  patient's  systems  or 
insistent  Ideas  with  disagreeable  moods  or  with  counter- 
acting systems,  or  by  a  clear  comprehension  of  the 
silliness,  and  lack  of  adaptation  of  the  Ideas  and  their 
ultimate  harm  to  the  patient,  by  a  realization  of  the 


336     Causation  and  Treatment,   Psychopathic  Diseases 

lack  of  rationality  and  meaning  of  the  recurrent  states. 
Again,  the  disintegration  may  be  accomplished  by  con- 
vincing the  patient  that  the  interpretation  he  puts  on 
the  facts  is  quite  erroneous,  and  that  the  meaning  is 
altogether  different  from  what  he  or  she  ascribes  to  the 
symptoms.  What  the  patient  thinks  as  meaning  ill- 
ness, sickness,  mental  or  physical,  is  really  either  indiffer- 
ent or  actually  the  manifestation  of  something  good 
and  healthy.  The  evil  may  thus  be  turned  to  good 
account.  This  may  be  done  directly  or  Indirectly  by 
various  insinuations  which  often  are  even  more  im- 
pressive and  lasting  than  direct  explanations. 

I  have  shown  in  my  ^^ Psychology  oj  Suggestion" 
that  of  the  forms  of  suggestion,  the  direct  and  the  in- 
direct, the  direct  suggestion  is  specially  adapted  to  the 
hypnotic  condition,  while  the  indirect  is  adapted  to  the 
waking  state.  It  Is  possible  to  use  both  forms,  the 
direct  and  indirect.  This  should  be  borne  in  mind 
when  we  are  using  the  various  methods  In  the  waking 
state  and  more  specially  In  the  hypnoidal  state,  a  state 
which  we  have  described  in  our  former  works  and  which 
we  shall  describe  further  on  In  this  volume. 

The  Method  of  Disintegration  by  interpretation  may 
be  practiced,  by  putting  a  special  construction  on 
the  experiences  and  the  symptoms  of  the  psychopathic 
patients.  Some  psychopathologists  express  It  by 
saying  that  they  find  the  "real  meaning"  of  the  symp- 
toms. In  other  words,  what  they  do  is  to  find  a  mean- 
ing which  Is  harmless  and  even  useful  to  the  patient  in 
his  adaptations  Instead  of  the  harmful  and  morbid  con- 
struction put  by  the  patient.  In  most  cases,  as  we  have 
pointed  out,  the  psychopathic  symptom  complex  lacks 
meaning,  it  is  simply  a  morbid  series  of  manifestations 
due  to  some  harmful  events,  associated  with  baneful 
experiences  of  early  child  life.  This  psychopathic 
symptom  complex  keeps  on  recurring,  reproducing  it- 


General  Psychotherapeutic  Methods  337 

"self  after  the  biological  type  of  the  recurrent  moment 
consciousness,  with  no  meaning  except  the  ones  that 
from  time  to  time  become  accidentally  associated  with 
it.  The  patient  may  at  one  time  give  one  construction 
and  at  another  time  may  give  a  totally  different  mean- 
ing to  the  symptom  complex.  "The  meaning"  depends 
entirely  on  the  patient's  mood  and  on  the  subsequent 
experiences  that  help  to  keep  up  the  fundamental 
symptom-complex.  The  patient  does  no  more  under- 
stand the  condition  than  the  savage  can  explain  the 
meaning  of  many  of  his  bizarre  and  absurd  rites.  The 
only  reason,  or  meaning  Is  the  very  fact  that  the  an- 
cestors of  the  savage  have  practiced  the  same  cus- 
toms from  time  immemorial. 

If  the  physician  learns  to  know  the  patient  well  and 
is  able  to  give  the  morbid  symptom  complex  a  deter- 
mination in  a  definite  direction  by  supplying  a  good, 
healthy  "meaning,"  and  Is  able  to  work  it  into  the 
tissue  of  the  patient's  personal  life,  a  good  deal  of  the 
battle  is  won.  On  the  one  hand  it  is  requisite  to  associ- 
ate the  morbid  manifestations  with  systems  which  are 
of  little  moment  to  the  patient,  so  that  he  should  under- 
estimate the  significance  of  the  morbid  manifestations; 
on  the  other  hand  the  good  manifestations  should  be 
associated  with  systems,  charged  with  emotion  of  vital 
import  in  the  patient's  personal  life.  In  this  way  the 
active  pathological  systems  become  dissociated  and 
disintegrated  into  their  component  parts,  and  finally 
disappear  from  consciousness  and  subconsciousness. 

This  method  of  disintegration  is  by  no  means  new. 
I  have  employed  it  for  many  years  under  various  con- 
ditions and  circumstances.  The  physician  has  to  be 
careful  In  the  use  of  this  method  not  to  associate  the 
disintegrated  portions  of  the  mental  systems  with 
emotions  or  instincts  which  may  indeed  for  some  time 
give  a  different  meaning  to  the  morbid  symptom  com- 


338    Causation  and   Treat7nent,    Psychopathic  Diseases 

plex  and  thus  deflect  the  discharge  of  energy  in  different 
directions  or  even  completely  inhibit  all  morbid  mani- 
festations of  energy,  but  may  work  incalculable  mis- 
chief in  other  directions.  Such,  for  instance,  is  the 
case  of  the  physician  who  plays  with  the  sex  in- 
stinct, keeps  on  arousing  the  intensity  of  the  sex 
instinct  and  thus  deflecting  the  morbid  activity  of  the 
psychopathic  systems  in  other  directions,  sexual  in 
character.  In  this  case  the  remedy  is  worse  than  the 
disease.  Such  patients  run  the  risk  of  being  morbidly 
introspective  in  the  direction  of  the  sex  instinct  into 
which  the  physician  deflected  the  activity  of  the  psycho- 
pathic groups.  I  have  seen  many  patients  who  have  be- 
come wrecks  under  the  treatment  carried  out  by  that 
harmful,  sexual,  introspective  analysis.  Treatment 
along  such  lines  should  be  discouraged  by  every  sincere, 
intelligent, and  conscientious  physician.  Nothing  can 
be  more  harmful  to  the  sensitive  and  already  damaged 
personality  of  the  pyschopathic  patient.  Many  a 
patient  came  to  me  ruined  in  mind  and  debauched  in 
soul  by  the  supposedly  well-meaning,  but  extremely 
harmful  sexual  analysis.  I,  therefore,  warn  the  physi- 
cian who  wishes  to  devote  his  time  to  the  practice  in 
Psychotherapy  to  avoid  sexual  analysis,  to  avoid  the 
formation  of  artificial  sexual  associations  which  in  the 
end  become  the  bane  of  the  patient's  life.  The  patient 
may  as  well  be  habituated  to  narcotics  to  still  his 
troubles.  Every  conscientious  and  intelligent  physician 
should  be  warned  against  the  use  of  such  detrimental 
and  damaging  treatment. 

We  have  pointed  out  in  our  works  that  "a  dissociated 
system  present  in  the  subconscious  when  coming  to  the 
surface  of  the  upper  strata  of  consciousness  becomes 
manifested  with  intense  sensori-motor  energy.  Dis- 
sociation gives  rise  to  greater  dynamogenesis.  This 
principle    of    dynamogenesis    is  important,     and  cases 


General  Psychotherapeutic  Methods  339 

of  so-called  impulsive  insanities  and  psychic  epilepsy 
are  really  due  to  this  cause,  and  are  studied  and 
treated  on  this  principle  with  great  success. 

"A  system  entering  into  the  association  with  other 
sytems  is  set  into  activity  not  only  directly  by  its  own 
appropriate  stimuli,  but  also  indirectly  through  the 
activities  of  the  various  systems  associated  with  it. 
These  associative  interrelations  bring  about  an  equable 
and  normal  functioning  activity,  controlled  and  regu- 
lated by  the  whole  mass  of  associated  systems.  The 
mass  of  associated  systems  forms  the  'reductives'  of 
each  individual  system.  In  dissociated  systems  the 
controlling  influence  of  the  '  reductive  mass'  is  lost  and 
the  result  is  an  over-activity,  unchecked  by  any  counter- 
acting tendencies. 

"This  relation  of  dissociation  and  dynamogenesis  is 
closely  related  to  periodicity  of  function  with  its  con- 
comitant manifestation  of  psychomotor  activity  charac- 
teristic of  all  passions  and  of  periodically  appearing 
instincts.  Dissociated  systems  present  impulsiveness, 
because  of  the  lack  of  associated  counteracting  systems. 
The  only  way  to  diminish  the  overpowering  impulsive- 
ness with  which  the  dissociated  subconscious  systems 
make  an  onset  in  their  rush  into  the  region  of 
personal  consciousness  is  to  bring  about  an  association, 
to  work  the  dissociated  systems  into  the  tissue  of  the 
patient's  consciousness. 

"Physiologically  it  may  be  said,  that  a  neuron  aggre- 
gate, entering  into  association  with  other  aggregates, 
and  being  called  into  activity  from  as  many  different 
directions  as  there  are  neuron  aggregates  in  the  associ- 
ated cluster,  has  its  neuron  energy  kept  within  the 
limits  of  the  physiological  level  of  the  total  energy  of 
the  neuron. 

"A  dissociated  neuron  aggregate,  on  the  contrary, 
is  not  affected  by  the  activity  of  the  aggregates;  it  is 


340     Causation  a7id   Treatment,    Psychopathic  Diseases 

rarely  called  upon  to  function,  and  hence  stores  up  a 
great  amount  of  neuron  energy.  When  now  an  appro- 
priate stimulus  liberates  the  accumulated  energy,  the 
activity  is  overwhelming  and  is  very  much  like  the 
eruption  of  an  underground  volcano,  giving  rise  to 
temporary  attacks,  to  'seizures'  by  subconscious 
states  of  the  whole  field  of  the  upper  consciousness, — 
'seizures'  which  being  really  of  the  nature  of  post- 
hypnotic automatisms  are  generally  mistaken  for 
epilepsy,  the  attacks  being  regarded  as  epileptic  mani- 
festations, as  'larval  epilepsy,'  as  'epileptic  equiva- 
lents,' as  'psychic  epilepsy.'  With  the  restoration 
of  equilibrium  of  the  neuron-aggregates,  with  the 
synthesis  of  the  dissociated  systems,  a  synthesis  which 
can  be  brought  about  by  different  methods,  the  sub- 
conscious eruptions,  attacks,  or  'seizures'  vanish  never 
to  return.  This  principle  of  synthesis  of  dissociated 
systems  is  clearly  demonstrated  in  our  researches. 

"In  cases  where  a  stably  organized,  pathological 
system  is  to  be  disintegrated  by  the  artificial  forma- 
tion of  counteracting  systems,  the  principle  of  dy- 
namogenesis  by  dissociation  is  of  the  highest  conse- 
quence." 

The  Method  of  Integration  or  Synthesis  is  to  be  used 
on  similar  lines.  The  systems,  requisite  in  the  building 
up  of  the  patient's  personality,  should  be  approached 
at  first  in  an  indirect  way.  By  all  forms  of  impressions, 
conscious  and  subconscious,  the  right  and  healthy 
minded  direction  should  be  indicated  to  the  patient. 
Normal  regulations  of  life  should  be  shown  in  such  a 
way  that  the  patient  should  think  that  he  himself  ar- 
rived at  them  voluntarily.  He  should  see  that  the 
right  course  is  the  one  for  him  to  follow,  and  that 
strength,  health,  and  energy  are  in  that  direction.  He 
must  see  clearly  for  himself  that  the  ways  he  followed 


General  Psychotherapeutic  Methods  341 

before  were  not  only  erroneous,  but  resulted  in  sickness, 
weakness,  physical  and  mental.  He  must  realize  that 
his  old  life  is  not  only  one  of  misery  to  his  family,  but 
also  to  himself,  that  the  fault  lies  with  himself  rather 
than  with  others.  The  psychopathic  patient  must 
learn  that  his  life  is  directed  on  wrong  lines,  that  he  has 
been  leading  a  poor  life,  mean,  short,  and  brutish;  that 
he  must  build  up  a  life  on  new  lines, — on  higher  in- 
tellectual and  moral  levels.  This  mental  up-building, 
this  anabolic  process,  must  be  accomplished  by  all 
kinds  of  ways,  by  enlarging  the  patient's  views  of  life, 
his  mental  horizon  through  courses  of  actual  studies, 
and  more  especially  by  force  of  intimate  example  and 
companionship.  Giving  books  to  the  patients  may  be 
all  right,  but  it  does  little  good.  What  is  needed  is  the 
personal  touch,  the  intimate  relationship,  the  example 
of  a  friendly  life  which  the  patient  may  follow  of  his 
own  free  decision. 

The  next  step  is  to  have  the  patient  act  out  his  good 
resolutions  and  decisions,  and  get  habituated  to  them. 
This  will  strengthen  the  new  habits  of  life  and  adjust- 
ments, while  it  will  weaken  the  old  habits  of  behavior. 
This  can  only  be  effected  when  the  patient  is  under 
personal  care  and  guidance.  The  physician  must  live 
with  the  patient.  Nothing  will  encourage  so  much  the 
patient  to  try  again  as  the  personal  interest  he  sees  the 
physician  takes  in  his  efforts.  Afterwards,  the  patient 
will  learn  to  do  for  its  own  sake  what  was  done  for 
approbation. 

Perhaps  it  may  be  well  that  the  physician  in  treating 
psychopathic  diseases  should  also  take  into  considera- 
tion the  fact  that  the  patients  are  characterized  by  the 
tendency  of  formation  of  habits  which  are  hard  to  break. 
The  patients  are  apt  to  ask  that  the  same  thing  be 
done  again  and  again  for  the  simple  reason  that  it  has 
been    done    several    times    before.     In    other    words, 


342     Causation  and   Treatment,  Psychopathic  Diseases 

psychopathic  neurosis  is  characterized  hy  automatism  and 
routine.  This  tendency  to  recurrence  is  characteristic 
of  all  forms  of  primitive  life  as  well  as  of  mental  activi- 
ties which  are  on  the  decline, — it  is  the  easiest  way  to 
go  along.  The  making  of  effort  is  specially  abhorrent 
to  the  patient,  and  in  fact  one  may  say  that  he  is  afraid 
of  change  in  the  same  way  as  the  savage  is  afraid  of  any 
novelty  or  of  any  change  in  custom.  The  tradition  is 
holy,  and  in  a  double  sense,  because  it  has  been  handed 
down  by  former  generations  who  are  regarded  as 
divine  and  superior,  and  because  the  new  is  strange 
and,  therefore,  may  prove  dangerous  and  of  evil  con- 
sequence. What  has  not  been  tried  may  prove  harm- 
ful, pernicious,  and  even  deadly.  The  old  has  been 
tried  and  approved  by  generations  and  the  conse- 
quences are  known,  while  the  new  may  be  in  alliance 
with  the  evil  powers.  The  same  holds  true  in  all  cases 
obsessed  by  the  impulse  of  self-preservation  and  the 
fear  instinct.  What  the  patients  have  tried  several 
times  and  what  has  proved  good  and  pleasant  is  in- 
sisted by  the  patient  on  being  repeated,  the  new  is 
not  known  and  may  be  risky,  dangerous.  I  have 
great  difficulty  in  making  changes  in  the  life  of  ad- 
vanced psychopathic  cases,  because  of  this  fear  of  the 
new,  neophobia.  Once  the  change  is  made,  and  the 
patient  becomes  adapted  to  the  new  way,  then  the 
old  way  is  shunned.  In  short,  neophobia  is  an  essential 
trait  of  psychopathic  patients. 

The  physician  must  take  this  trait  of  neophobia  into 
account,  and  as  the  patient  begins  to  improve,  he  must 
gradually  and  slowly  wean  the  patient  of  this  phobia, 
inherent  in  the  very  nature  of  the  malady.  The  patient 
must  learn  to  do  new  things,  and  not  simply  follow 
mechanically  a  regime,  laid  out  by  the  physician  or 
by  the  nurse.  The  life  must  be  personal.  The  patient 
should  be  made  to  change  many  of  his  ways,  and  above 


General  Psychotherapeutic  Methods  343 

-A 
all  he  should  learn  to  follow  reason  rather  than  habit 

and  routine.  Everything,  as  much  as  possible,  should 
be  reasoned  out,  he  should  be  able  to  give  a  rational 
account  of  his  habits  and  actions.  Whatever  appears 
to  be  a  matter  of  routine,  irrational  and  unaccountable 
habit,  simply  a  matter  of  recurrence,  of  repetition  of 
action  should  be  discarded,  should  be  changed  to  ac- 
tions and  adaptations  for  which  the  patient  could  give 
a  rational  account.  We  must  remember  that  the 
patient  lives  in  the  condition  of  recurrent  mental  states, 
that  his  mental  activity,  as  I  have  pointed  out,  follows 
the  laws  of  recurrence,  characteristic  of  the  type  of  re- 
current moment  consciousness.  It  is,  therefore,  the 
physician's  object  to  lift  the  patient  out  of  this  low 
form  of  mental  activity  to  the  higher  types  of  rational, 
personal  life  in  which  the  patient  can  rise  above  the 
perturbations  of  life,  above  the  pettiness  of  existence 
with  its  worries  and  fears.  This  procedure  is  essential. 
We  can  realize  how  pernicious  those  schemes  are 
which  physicians  and  many  people  in  sanitariums  lay 
out  for  the  patients  just  to  keep  them  busy  for  the  time 
of  their  stay  under  special  care.  As  soon  as  the  patients 
leave,  they  are  in  the  same  predicament  as  before. 
The  patients  wish  to  have  their  lives  conducted  in  the 
same  mechanical,  automatic  routine.  In  this  way 
they  are  really  on  the  same  low  plane  of  mental  life,  on 
the  plane  of  recurrent  moment  consciousness,  a  type 
which  forms  the  pathological  web  and  woof  of  the 
patient's  life.  Unless  the  patient  is  lifted  out  of  this 
low,  mean,  and  animal  form  of  conscious  activity,  he 
cannot  be  regarded  as  cured.  Instead  of  having  the 
patient's  life  saturated  and  controlled  by  the  recurrent 
automatisms  of  the  fear  instinct,  he  should  learn  to  be 
controlled  by  the  light  of  reason.  "A  free  man  is  he," 
says  Spinoza  "who  lives  under  the  guidance  of  reason, 
who  is  not  led  by   fear."     Epicurus   and   the   ancient 


344     Causation  and   Treatment^  Psychopathic   Diseases 

Epicureans  laid  special  stress  on  the  necessity  of  getting 
rid  of  fear  through  reason,  enlightenment,  and  educa- 
tion.    Thus  the  great  poet  Lucretius: 

"The  whole  of  life  is  a  struggle  in  the  dark.  For 
even  as  children  are  flurried  and  dread  all  things  in  the 
thick  darkness,  thus  we  in  the  daylight  fear  things  not 
a  whit  more  to  be  dreaded  than  those  which  children 
shudder  at  in  the  dark  and  fancy  future  evils.  This 
terror,  therefore,  and  darkness  of  mind  must  be  dis- 
pelled not  by  the  rays  of  the  sun  and  glittering  shafts  of 
day,  but  by  a  knowledge  of  the  aspect  and  law  of  na- 
ture. " 

As  Carlyle  tersely  puts  it;  "The  first  duty  of  a  man 
is  still  that  of  subduing  Fear.  We  must  get  rid  of  Fear; 
we  cannot  act  at  all  till  then.  A  man's  acts  are  slavish, 
not  true  but  specious  (we  may  add  psychopathic);  his 
very  thoughts  are  false,  he  thinks  too  as  a  slave  and 
coward,  till  he  have  got  Fear  under  feet.  .  .  Now 
and  always,  the  completeness  of  his  victory  over  Fear 
will  determine  how  much  of  a  man  he  is". 

The  patient  complains  of  lack  of  confidence.  This 
is  a  pathognomonic  symptom  of  psychopathic  states. 
At  the  same  time  there  is  confidence  in  the  symptom 
complex  which  is  often  described  by  him  with  micro- 
scopic minuteness.  The  patient  has  no  doubt  about 
that.  The  patient  is  in  search  of  someone  who  can  over- 
come this  sym  ptom  complex  in  a  way  which  he  specially 
approves.  The  patient  matches  the  symptoms  against 
the  physician's  control.  The  physician  is  to  be  sub- 
dued by  the  authority  of  the  diseased  personality,  by 
the  ruling  symptoms  of  the  patient's  life.  Either  the 
physician  meets  with  opposition,  and  after  some  time, 
must  give  up  the  treatment  of  the  case,  or  he  is  victim- 
ized by  the  patient's  demands,  and  must  comply  with 
them.  In  the  last  case  the  patient  may  stick  to  the 
physician  for  some  time.     In  both  cases  the  patient  is 


General  Psychotherapeutic  Methods  345 

not  really  cured.  It  is  only  when  the  patient's  diseased 
self  becomes  subdued  and  falls  under  the  physician's 
control,  it  is  only  then  that  a  cure  is  really  possible. 

The  first  and  foremost  characteristic  of  psychopathic 
states  is  the  narrowing  down  of  the  patient's  life  in- 
terests. The  patient  begins  to  lose  interest  in  general, 
abstract  problems,  then  in  that  of  his  own  profession  or 
occupation,  then  he  loses  interest  in  the  welfare  of  his 
party  or  his  country,  and  finally,  in  his  family,  wife, 
and  children.  Even  in  the  case  of  lovers  the  psycho- 
pathic patient  seeks  to  utilize  the  person  he  loves  for  his 
own  benefit,  namely,  his  health.  He  loves  the  person 
as  a  wolf  loves  a  lamb.  The  self  becomes  narrowed 
down  to  health,  the  key  to  his  supposed  spiritual  life. 
This  is  clearly  seen  in  the  case  of  Christian  scientists. 
Self-preservation  and  fear  permeate  the  patient's  life. 

We  notice  that  the  patient's  life  activity,  especially 
his  mental  life  becomes  narrowed  down.  His  attention 
becomes  circumscribed  to  a  few  subjects  and  objects. 
This  is  the  limitation  of  the  extent  of  attention.  There 
is  afterward  a  limitation  of  the  temporal  span  of  atten- 
tion. The  patient  cannot  keep  his  attention  on  any 
subject  for  any  length  of  time.  This  span  of  attention 
becomes  more  and  more  limited  with  the  growth  and 
severity  of  the  psychopathic  malady.  If  the  patient 
is  educated  and  has  had  an  interest  in  various  subjects, 
the  latter  becomes  more  and  more  limited  in  scope. 
Finally  the  patient  becomes  reduced  to  the  least  amount 
of  effort  of  the  attention,  and  that  only  for  a  brief  period 
of  time.  When  the  trouble  reaches  its  climax,  the 
patient  loses  all  interest  and  capacity  of  reading  and  of 
studying.  He  cannot  think,  he  becomes  less  and  less 
original  in  his  thought,  he  becomes  even  incapable  of 
thinking.  The  patient's  whole  mind  becomes  limited 
to  himself  and  to  the  symptoms  of  his  disease. 

Along  with  it  the  fear  instinct  grows  in  power  and 


346     Causation  and   Treatment,  Psychopathic  Diseases 

inhibits  all  other  activities.  There  is  a  limitation  of 
the  patient's  personal  self.  The  personality  becomes 
reduced  to  the  lowest  levels  of  mere  existence  and  caring 
for  his  own  selfish  pains  and  small  pleasures  which  are 
exaggerated  and  magnified  to  an  extraordinary  degree. 
In  other  words,  the  personal  life  of  the  patient 
becomes  more  and  more  limited  as  the  pathological 
process  goes  on.  It  becomes  harder  and  harder  for 
the  patient  to  take  an  active  interest  in  life,  to  exercise 
his  functions,  his  life  interests  as  well  as  his  life  activi- 
ties. 

It  is  clear  that  under  such  conditions  the  tendency 
of  the  patient  is  to  rest  and  brood  about  himself,  and 
keep  indulging  his  limited  interest  which  gets  still  more 
limited  as  the  pathological  process  becomes  more  ex- 
tensive and  intensive.  Under  such  conditions  it  is 
suicidal  to  indulge  the  patient  and  suggest  to  him  a  rest 
cure,  a  cure  which  lies  along  the  line  of  the  disease 
process,  thus  tending  to  intensify  the  symptom  com- 
plex. What  the  patient  needs  is  to  change  his  environ- 
ment, and  be  put  under  conditions  in  which  his  interests 
of  life  can  be  aroused,  his  life  activities  can  be  stimu- 
lated to  functioning  on  the  right-  lines,  laid  out  by 
physicians  who  understand  the  patient's  condition. 

What  we  must  remember  in  the  treatment  of  psycho- 
pathic patients  is  the  fact  that  we  deal  here  with  the 
aberrations  of  the  impulse  of  self-preservation,  the  most 
powerful,  the  most  fundamental  and  the  least  uncontroll- 
able of  animal  impulses,  and  with  the  fear  instinct  which 
is  the  most  primitive  of  all  animal  instincts.  This 
morbid  state  of  the  impulse  of  self-preservation  must  be 
fully  realized  by  the  physician  before  any  treatment  is 
begun.  The  physician  must  also  see  and  study  closely 
the  line  on  which  the  self-preservation  impulse  is  tend- 
ing, and  to  comprehend  the  associations  along  which 


General  Psychotherapeutic  Methods  347 

the  Impulse  takes  its  course  in  the  history  of  the  patient 
and  in  the  symptom  complex. 

What  the  physician  must  specially  look  after  is  the 
elusive  feeling  of  self-pity  which  manifests  itself  under 
various  garbs,  and  hides  itself  under  all  kinds  of 
forms.  As  long  as  the  patient  is  introspective  and 
has  the  emotional  side  of  self-pity  present,  so  long  is  his 
condition  psychopathic. 

The  patient's  history  should  be  inquired  into  very 
closely  and  while  one  reviews  his  history  one  may  get  a 
chance  to  point  out  to  him  indirectly  the  various 
psychopathic  faults  from  which  he  suffers  and  which 
must  be  overcome  and  corrected.  This  has  to  be  done 
by  the  method  of  indirect  association  or  suggestion. 
This  method  is  of  the  utmost  importance  in  the  treat- 
ment of  psychopathic  states.  The  method  of  direct 
association  or  suggestion  should  also  be  practiced  both 
in  waking  and  trance  states,  hypnotic  and  hypnoidal. 
The  physician,  however,  will  find  that  the  method  of 
indirect  association  or  suggestion  will  have  to  be  em- 
ployed all  through  the  course  of  the  treatment.  All 
the  surroundings  of  the  patient  must  be  of  such  a 
character  as  to  continually  arouse  indirectly  thoughts, 
feelings,  and  emotions  which  should  neutralize  the 
patient's  feelings  and  emotions,  and  should  control  his 
fears  and  his  abnormally  developed  impulse  of  self- 
preservation.  He  must  learn  self-control  in  the  pres- 
ence of  other  people,  and  finally  even  when  other 
people  are  away;  he  must  give  up  self-pity  as  ludicrous 
and  degrading. 

The  extreme  selfishness  and  the  uniqueness  with 
which  the  psychopathic  patients  regard  their  own  con- 
dition should  be  eradicated  from  their  mind.  It  must 
be  impressed  on  them  that  their  case  is  quite  common 
and  that  there  Is  nothing  exceptional  about  them.  It 
must  be  made  clear  to  them  that  the  whole  trouble  is  a 


348      Causation  and   Treatment,  Psychopathic  Diseases 

matter  of  mal-adjustment,that  they  have  developed  inor- 
dinately the  impulse  of  self-preservation  and  the  fear  in- 
stinct until  their  mental  life  has  become  morbid  and  twist- 
ed. The  whole  personality  has  to  be  readjusted.  It  is 
the  special  tendency  of  psychopathic  patients  to  regard 
themselves  as  unique,  privileged  above  all  other  patients, 
they  are  a  kind  of  geniuses  among  the  afflicted,  pos- 
sibly on  account  of  the  special  endowments  possessed 
by  them,  gifts  of  quite  exceptional  and  mysterious  a 
character.  "Have  you  ever  met  with  a  case  like  mine.'*" 
is  the  stereotyped  phrase  of  the  psychopathic  patient. 
As  long  as  the  patient  entertains  that  conception  of  no- 
bility the  impulse  of  self  must  still  be  regarded  as 
morbid. 

He  must  be  made  to  understand  clearly  that  there  is 
no  aristocracy  in  disease,  and  that  there  is  no  nobility 
of  the  specially  elect  in  the  world  of  morbid  affections 
any  more  than  there  is  in  the  domain  of  physical  mala- 
dies. 

The  egocentric  character  of  the  psychopathic  patient 
puts  him  in  the  position  of  the  savage  who  takes  an 
animistic,  a  personal  view  of  the  world  and  of  the 
objects  that  surround  him.  The  forces  are  regarded  as 
dealing  specially  with  man  and  his  fate,  often  conspiring 
against  man.  Magic  is  the  remedy  by  which  he  tries 
to  defend  himself  and  even  to  control  the  inimical  or 
friendly  natural  forces  or  objects,  animate  and  inani- 
mate, with  which  he  comes  in  contact.  This  same 
attitude,  animistic  and  personal,  of  the  primitive  man 
is  present  in  the  psychopathic  patient.  The  patient  is 
afraid  that  something  fearful  may  happen  to  him. 
Against  such  accidents  he  takes  measures  often  of  a 
defensive  character  which  differ  but  little  from  the 
magic  of  the  savage  and  the  barbarian.  The  whole  of 
nature  has  the  patient  as  its  centre  and  may  crush  him. 
That  is  why  these  patients  are  the  victims  of  all  kinds 


General    Psychotherapeutic    Methods       349 

of  fakes,  schemes,  panaceas  of  the  wildest  type,  un- 
scrupulous patent  medicines,  absurd  regimes,  mental 
and  religious,  whose  silliness  and  absurdity  are  patent 
to  the  unprejudiced  observer.  The  mental  state  of 
the  psychopathic  patient  Is  that  of  the  savage  with  his 
anthropomorphic  view  of  nature,  with  his  fears  based 
on  the  impulse  of  self-preservation.  The  psychopathic 
patient  is  In  a  state  of  credulity  with  its  faith  in  magic. 

The  emotional  side  of  the  impulse  of  self-preserva- 
tion and  of  the  fear  Instinct  should  always  be  kept  In 
mind  by  the  physician  who  undertakes  the  treatment 
of  psychopathic  cases.  The  physician  must  remember 
that  the  emotions  in  such  cases  are  essentially  of  the 
Instinctive  type,  that  they  therefore  lie  beyond  the  ken 
of  the  patient's  immediate  control  and  action  of  the 
personal  will.  The  physician  should  not  therefore  be 
impatient,  but  while  protecting  the  Invalid  against  the 
fears  that  assail  the  latter,  he  should  gradually  and 
slowly  undermine  the  violence  of  the  impulse  of  self- 
preservation  and  the  anxiety  of  the  fear  instinct.* 

We  have  pointed  out  that  under  the  fear  instinct  are 
comprehended  all  concomitant  sensory  processes,  gland- 

*Although  I  lay  stress  on  the  instinctive  aspect  of  the  fear  emotion,  I  do 
not  agree  with  those  who  lay  down  the  law  that  all  instincts  have  an  emotion- 
al side  to  them,  who  go  even  to  the  extent  of  claiming  that  the  emotion  is 
the  characteristic  trait  of  instinct  in  general.  I  cannot  agree  to  such  an 
extreme  statement,  simply  because  the  facts  do  not  warrant  it.  There  are 
instincts  with  no  emotions  and  there  are  emotions  with  no  instinctive  side 
to  them.  The  instincts  of  the  Crustacea  or  of  the  Annelidae  are  hardly  of  an 
emotional  character;  it  is  questionable,  if  the  instincts  and  the  biological 
tropisms  of  lower  life  have  anything  emotional  about  them,  and  it  is  not 
certain  if  in  the  case  of  Mahnmalia  or  even  in  the  case  of  the  human  infant 
just  born  the  instincts  present  are  in  any  way  emotional.  The  early  primi- 
tive instincts,  ontogentic  and  phylogenetic,  in  all  likehood  lack  that  emotion- 
al character  which  is  probably  a  characteristic  only  of  the  high  types  of 
psycho-physiological  organization.  We  may,  however,  grant  that  in  the 
case  of  the  psychopathic  patient  the  instincts  are  charged  with  emotional 
energy,  since  the  emotional  element  is  a  predominant  factor  in  such  neuroses 
and  psychoses.  We  have  shown  in  our  works  that  the  manifestation  of 
such  instinctive  energy,  as  subconscious  and  inhibited,  is  eruptive  in  char- 
acter, giving  rise  to  attacks  often  of  a  violent  nature. 


350     Causation  and   Treatment,  Psychopathic  Diseases 

ular,  Intestinal,  respiratory,  and  motor  reactions  to 
external  and  internal  stimulations,  as  well  as  sensory, 
perceptual,  and  ideational  processes.  All  these  pro- 
cesses enter  as  elements  into  the  emotions,  and  especial- 
ly into  that  psycho-biological  reaction  known  as  the 
fear  instinct.  The  emotional  and  instinctive,  psy- 
cho-physiological processes,  may  be  looked  at  from  a 
three-fold  standpoint,  from  the  afferent,  central,  and  ef- 
ferent. Some  psychologists  emphasize  the  central  and 
others,  especially  of  recent  date,  are  apt  to  over-empha- 
size the  efferent  and  afferent  aspects  of  emotion  in  gen- 
eral and  of  instinct  in  particular.  As  a  matter  of  fact 
all  the  three  aspects  enter  Indlssolubly  Into  emotion  and 
instinct  wherever  the  two  are  in  any  way  associated. 
In  the  treatment  of  the  fear  Instinct  which  underlies 
all  psychoneurotic  and  psychosomatic  cases  one  must 
bring  about  the  modification  of  that  instinct  with  its 
fundamental  Impulse  of  self-preservation. 

Tn  utilizing  the  principle  of  metathesis  and  modifica- 
tion which  we  have  pointed  out  In  our  previous  chapters 
of  this  work,  one  must  take  into  consideration  the  various 
aspects  of  the  self-Impulse  and  fear  Instinct,afferent,  effer- 
ent, and  central.  All  the  elements  must  be  affected  In 
order  to  obtain  satisfactory  results.  Some  psychol- 
ogists claim  that  the  sensory  and  central  elements  are 
unmodifiable,  and  that  only  the  efferent,  motor  elements 
can  be  modified  in  the  emotions  and  impulses.  This 
claim  Is  not  justifiable  by  facts.  My  clinical  facts  and 
cases  go  to  show  that  such  a  claim  Is  untenable.  All 
the  elements  entering  into  an  emotion  are  modifiable,  and 
are  being  modified  in  the  course  of  ontogenetic  devel- 
opment of  the  Individual  as  well  as  the  phylogenetic 
evolution  of  varieties,  species,  and  genera.  The  sensory 
elements  and  mentaP  states,  going  to  make  up  the 
afferent  states  of  the  emotions,  keep  on  changing,  and 
so  do  the  central  elements  and  states,  the  qualitative 


General  Psychotherapeutic  Methods  351 

feeling  and  ideational  aspects  into  which  the  afferent 
and  efferent  elements  enter  as  constituent  components. 
All  that  we  can  possibly  claim  is  that  sensory  elements 
are  more  modifiable  than  central,  and  that  the  motor 
are  more  modifiable  than  the  sensory  elements.  Even 
this  statement  is  subject  to  restriction.  It  is  not  that 
the  sensory  elements  and  central  states  are  less  mod- 
ifiable than  the  efferent,  motor  elements  and  states, 
but  that  the  latter  are  more  modifiable,  because  they 
are  more  accessible  to  external  and  internal  influences. 

From  the  standpoint  of  the  amount  of  modifiability  we 
may  say  that  the  central  element  and  states  are  even 
more  modifiable  than  all  the  other  elements,  since  they 
form  the  psycho-physiological  products  of  all  the 
afferent,  incoming  stimulations,  both  purely  sensory 
and  kinaesthetic  processes.  In  other  words,  inasmuch 
as  the  central  elements  form  the  product  of  the  afferent 
and  efferent  processes  from  the  sensory  incoming 
stimulations,  from  the  motor  processes  and  glandular 
reactions,  the  the  central  elements  and  states  may  he 
regarded  as  being  more  modifiable  than  all  the  other 
elements.  It  is  not  because  motor  elements  are  in- 
trinsically more  modifiable  than  sensory  and  affective 
elements,  but  because  movements  are  directly  accessible 
to  our  control  than  are  peripheral  sensory,  central,  and 
emotional  processes  in  general.  It  is  not  that  the 
afferent  and  central  emotional  elements  are  not  modifi- 
able per  se,  as  some  would  have  it,  but  because  the 
efferent  or  motor  elements  are  easier  to  modify.  I 
quote  from  a  work  of  mine  written  by  me  some  fifteen 
years  ago.  Since  the  generalization  is  of  import,  both 
from  a  theoretical  and  practical  therapeutic  as  well  as 
an  educational  standpoint,  and  since  some  have  misap- 
prehended it  by  overstatement,  I  take  the  liberty  of 
quoting  at  some  length: 

"Ideo-motor  life  is  more  subject  to  changes  from 


352     Causation  and   Treatment,   Psychopathic  Diseases 

slight  stimulations  than  sensory  life:  motor  elements 
enter  readily  into  new  combinations.  From  a  biological 
standpoint  one  can  see  the  importance  of  the  greater 
ease  of  modifiability  displayed  by  sensori-motor  ele- 
ments, since  in  the  adaptation  of  the  organism  to  its 
environment  it  is  these  elements  that  are  mainly  em- 
ployed in  reaction  to  stimuli  of  the  external  world. 
From  the  standpoint  of  adaptation,  a  slightly  appreci- 
able difference  of  sensory  experience  may  give  a  widely 
different  and  highly  complex  motor  reaction. 

"Psychomotor  processes  form  the  most  important  and 
largest  portion  of  mental  life.  With  the  exception  of 
man,  all  the  representatives  of  the  animal  kingdom, 
from  the  lowest  to  the  highest  forms,  represent  but 
different  stages  in  the  evolution  of  sensori-motor  life. 
The  great  majority  of  mankind  still  leads  a  life  closely 
allied  to  animal  sensori-motor  states.  Even  in  the 
highest  and  most  developed  forms  of  mental  activity, 
motor  ideas  and  representations  are  by  far  the  most 
predominant.  Without  motor  elements,  ideational  life 
is  arrested.  It  is  these  sensori-motor  and  ideo-motor 
elements  that  constitute  the  'stream,  the  flow,  the 
current'  of  our  thoughts.  Motor  elements  enter 
freely  into  combinations  with  all  other  elements  of 
mental  life.  This  freedom  in  forming  new  combina- 
tions and  associations  makes  the  suggestion  of  motor 
ideas  and  representations  highly  effective. 

"Throughout  the  scale  of  animal  life  from  the  lowest 
to  the  highest  forms,  intelligence  is  intimately  related 
to  the  degree  of  development  of  the  musuclar  system 
and  the  delicacy  of  its  motor  adjustment.  Among  the 
lower  forms  of  life,  the  Cephalopods  are  well  equipped 
with  powerful  muscular  arms  capable  of  executing  a 
great  variety  of  vigorous  movements.  Now  the  Cepha- 
lopods also  possess  a  more  highly  developed  nervous 
system  with  a  higher  grade  of  mental  functions  than 


General  Psychotherapeutic  Methods  353 

the  rest  of  the  Mollusca.  The  great  activity  of  ants 
and  bees  is  notorious  and  their  instinctive  psychic  life 
is  the  richest  among  the  Arthropoda.  Note  the  great 
variety  of  motor  adjustments  of  the  beaver  and  also 
the  intelligence  that  goes  along  with  it.  Birds  possessed 
of  a  high  degree  of  activity  and  motor  adaptability  are 
also  the  most  intelligent  of  their  kind,  such  for  instance 
as  the  crow  and  the  different  species  of  talking  birds. 
Notice  the  activity  and  great  agility  of  the  fox  and  also 
the  unusual  cunning  for  which  he  is  so  celebrated.  The 
suppleness  of  the  dog,  his  quick  reactions  to  stimula- 
tions, the  resources  of  his  motor  adjustments,  and  the 
great  extent  of  his  modifiability  under  changing  condi- 
tions, are  all  well  known,  and  along  with  them  goes  a 
high  degree  of  psychosis.  Of  all  the  Mammals,  the 
Quadrumana  are  the  most  active,  the  most  imitative 
and  full  of  mimicry,  and  with  the  exception  of  man 
they  are  also  the  most  intelligent.  When  we  come  to 
man  we  cannot  help  admiring  the  high  complexity  and 
extreme  delicacy  of  his  motor  adjustments.  Most 
marvellous,  however,  is  the  human  hand,  that  divine 
organ  which  gives  shape  and  form  to  works  of  art,  to  all 
the  outward,  visible  manifestations  of  civiHzation.  The 
great  artists  and  thinkers  of  antiquity  held  the  human 
hand  in  great  reverence.  One  of  the  great  Greek 
philosophers  did  not  even  hesitate  to  declare  that 
man's  superiority  over  the  brute  was  due  to  his  hand. 
Finally,  in  the  wonderfully  delicate  motor  adjustments 
of  speech  we  find  clearly  illustrated  the  intimate  rela- 
tion between  motor  and  psychic  activities. 

"Experiments  prove  the  same  truth  of  the  predomi- 
nance of  motor  ideas  and  representations  in  our  mental 
life.  If  a  series  of  syllables  or  numbers  is  given  to 
memorize  after  one  reading,  five  out  of  ten  can  be 
remembered,  though  with  some  difficulty;  but  if  the 
syllables  or  numbers   are  written  down  at  the  same 


354     Causation  and  Treatment,  Psychopathic  Diseases 

time,  though  not  looked  at  during  the  writing,  a  far 
greater  percentage,  such  as  six  or  seven  syllables,  can 
be  remembered.  If  the  motor  elements  in  a  train  of 
ideas  are  suppressed,  the  order  of  the  series  becomes 
confused,  and  even  destroyed,  showing  that  the  motor 
ideas  are  important  links  in  trains  of  association  of 
ideas. 

"Biologically  regarded,  voluntary  activity — will  is 
the  organism's  power  of  adjustment  to  the  conditions 
of  the  external  environment.  In  its  last  psychological 
analysis,  voluntary  activity,  or  will,  consists  of  repre- 
sentations of  various  modes  of  adaptations — that  is,  of 
motor  memories,  of  highly  complex  systems  of  kin- 
aesthetic  representations,  constituting  the  active  sub- 
ject of  the  highly  developed  personality.  If  this  be 
realized,  then  the  vital  importance  of  motor  memories 
cannot  be  too  highly  overrated.  Motor  memories  are 
at  the  very  heart  of  personality.  We  are  what  we  can 
accomplish.  Extreme  variability  and  adaptability  are 
the  main  characteristic  traits  of  intelligence,  will,  per- 
sonality, with  their  motor  memories  as  their  central 
nuclei. 

"The  readiness  of  psychomotor  elements  and  groups 
to  enter  into  ever  new  combinations  gives  rise  to  the 
formation  of  a  great  wealth  of  associations  which  help 
to  make  the  labile  psychomotor  groups  and  systems 
stable  and  easy  of  recall.  In  fact  it  may  be  said  that 
the  ease  of  recall  is  proportionate  to  the  mass  of  associated 
kinaesthetic  memories.  If  under  the  action  of  adverse 
conditions  associations  are  dropped  or  lost,  many  more 
still  remain  to  recall  the  affected  system,  some  of  the 
functional  bonds  of  which  have  become  loosened.  The 
great  wealth  of  associations  formed  by  motor  memories 
brings  about  their  ease  of  recall,  also  their  recurrence 
in  consciousness  even  under  unfavorable  conditions  of 
dissociation.     The  great  modifiability  and  variability 


General  Psychotherapeutic  Methods  355 

of  systems  of  motor  memories  requisite  in  the  adapta- 
tion of  the  organism  to  the  varying  condition  of  its 
environment  make  the  ever  greater  instability  of  motor 
memories  an  imperative  necessity  in  the  struggle  for 
existence.  Forming  the  predominant  elements,  both 
as  to  intensity  and  mass,  of  the  most  complex,  relatively 
stable,  though  ceaselessly  shifting  groups  and  systems 
constituting  the  highly  developed  organization  of  the 
personal  self,  the  motor  elements,  presentative  and  repre- 
sentative, are  also  the  first  to  become  involved  in  the  process 
of  dissociation.  In  the  various  forms  of  nervous  and 
mental  diseases,  under  different  conditions  of  intoxica- 
tion and  auto-intoxication,  in  the  traumas  caused  by 
shock,  physical  or  psychic,  the  delicate  movements  of 
adjustments  are  the  first  to  become  affected,  dissocia- 
tions of  systems  of  motor  representations  are  first  to 
occur  with  their  concomitant  motor  derangements. 

"The  instability  of  motor  memories  and  of  psycho- 
motor elements  in  general  may  be  brought  into  relation 
with  the  fact  of  the  early  affection  of  muscular  and 
kinaesthetic  sensibilities,  and  with  the  predominance 
of  sensori-motor  over  purely  sensory  symptoms  so  fre- 
quently occurring  in  the  course  of  nervous  diseases. 
With  this  may  be  correlated  the  significant  fact  referred 
to  by  Mosso,  that  *all  substances  which  slowly  destroy 
the  organism  must  produce  phenomena  analogous  to 
those  of  curari,  since  the  motor  nerves,  according  to 
our  researches,  have  less  vitality  than  the  sensory.'  It 
would  be  more  correct  to  substitute  for  'motor'  the 
term  'sensori-motor,'  because  muscular  and  kinaesthetic 
sensibilities  are  also  involved  in  the  same  process  of 
degeneration.  It  may  also  be  observed  in  passing,  that 
cellular  kinoplasm  with  the  'kinocentrum,'  the  centro- 
some  and  its  archoplasmic  structures,  possibly  the 
most  primitive  motor  organoids  of  the  cell,  similarly 
manifest  a  high  degree  of  variability  and  instability. 


3S6     Causation  and  Treatment,  Psychopathic  Diseases 

"Motor  memories  may  be  regarded  as  the  labile 
elements  of  consciousness;  they  become  easily  and  fre- 
quently dissociated  and  dropped  into  the  subconscious, 
but  for  that  very  reason  they  are  also  very  easily  repro- 
duced or  regenerated.  In  this  respect  motor  memories 
follow  the  general  biological  law  of  organic  regeneration : 
Organs  that  are  easily  and  frequently  lost  in  the  struggle 
for  existence  are  also  easily  regenerated,  as  for  instance, 
the  legs  and  claws  of  Crustacea  or  the  tentacles  of  the 
starfish  and  octopus..  Dissociated  systems  of  motor 
memories  often  become  regenerated  and  under  patho- 
logical conditions  when  synthesis  is  impossible  they 
may  even  recur  with  great  insistence,  giving  rise  to 
the  most  uncontrollable  types  of  insistent  ideas  and 
impulses  and  to  various  forms  of  so-called  "psychic 
epilepsy,'  especially  of  the  motor  type,  closely  mimick- 
ing typical,  organic  epilepsy.  Dissociated,  subconscious 
systems,  like  rudimentary  aborted  organs,  are  very 
persistent  and  often  very  injurious  to  the  organism. 
The  recurrence  of  the  subconsciously  submerged  disso- 
ciated systems  has  its  parallel  in  the  biological  phe- 
nomena of  reversion,  or  atavism.  The  development, 
growth,  and  recurrent  persistence  of  a  subconscious 
dissociated  system  is  like  a  malignant  sarcomatous 
neoplasm  the  cells  of  which  present  a  reversion  to  the 
embryonic  type. 

"This  fact,  that  the  psychomotor  elements,  motor 
ideas  and  representations,  enter  more  easily  into  com- 
binations and  form  extensive  associative  systems, 
makes  them  easier  of  recall,  and  hence  apparently  more 
persistent  in  memory.  From  an  educational  stand- 
point, one  realizes  the  importance  of  this  fact  of  per- 
sistent recurrence  and  great  ease  of  recall  of  motor 
memories.  Children  learn  and  remember  things  best, 
not  by  abstract  notions,  not  by  looking  at  objects  and 
hearing  of  things,  but  by  acting  out  whatever  is  taught 


General  Psychotherapeutic  Methods  357 

them.  Not  only  is  the  interest  increased  on  that  ac- 
count and  knowledge  made  more  vital  and  better  assimi- 
lated, but  the  content  acquired  is  also  far  better  re- 
tained and  more  easily  remembered;  it  emerges  with 
greater  ease  and  is  at  the  child's  command  at  any  time, 
because  of  the  nature  of  the  interwoven  motor  memo- 
ries. In  the  training  of  the  mentally  defective,  the  best 
method  followed  is  that  of  motor  instruction;  the  best 
way  of  teaching  the  mentally  defective  is  to  have  the 
ideas  acted  out  and  from  the  actions  get  at  the  mean- 
ing, even  if  it  be  only  automatically,  of  what  is  requisite 
to  be  learned.  As  a  matter  of  fact,  even  the  perfectly 
normal  and  well  balanced  mind  gets  at  the  meaning  of 
things  by  handling  them,  by  having  the  attributes  of 
the  object  and  the  processes  of  the  work  to  be  learned 
acted  out.  Acting  forms  the  greater  part  of  marCs 
life.     .     .      . 

"For  therapeutic  purposes  it  is  certainly  of  im- 
portance to  have  the  suggestion  (influence,  modification) 
as  stable  as  possible.  To  effect  this,  the  best  way  is  to 
utilize  this  fact  of  persistence  of  sensori-motor  and 
ideo-motor  elements,  of  the  greater  ease  of  recall 
characteristic  of  kinaesthetic  sensations  and  ideas. 
Motor  and  kinaesthetic  sensations  and  memories  make 
suggestions  durable. 

"It  is,  of  course,  preferable  that  the  associated  motor 
memories  should  not  be  of  a  passive,  but  of  an  active 
character.  To  guide  and  move  the  patient's  limb,  for 
instance,  is  not  as  good  as  when  he  carries  out  the  acts 
of  his  own  accord.  In  other  words,  active  kinaesthetic 
associations  are  most  potent.  Along  with  other  meth- 
ods, use  of  kinaesthetic  associations  is  of  the  greatest 
value  in  the  process  of  formation  and  also  of  disintegration 
of  a  stably  orga7iized  system." 

This  comes  down  to  the  practical  principle  of  in- 
fluencing the  patient's  personality  through  an  actual 


358     Causation  and   Treatment,  Psychopathic  Diseases 

change  of  his  mode  of  life.  The  tendency  in  the  treat- 
ment is  to  make  the  patient  work  on  right  Unes,  not  to 
have  him  work  at  his  regular  occupation,  or  to  lay  out 
for  him  some  artificial  trade,  as  it  is  done  in  some  places, 
the  patient  being  made  to  do  definite  tasks  at  certain 
specified  times  and  in  a  definite,  automatic  way.  Noth- 
ing can  be  more  calculated  to  keep  up  the  psychopathic 
condition  of  recurrent,  mental  life.  The  patient  should 
be  in  the  open  air,  he  should  be  active,  but  his  activity 
should  he  voluntary,  spontaneous.  The  activity  should 
not  only  strengthen  him,  it  should  help  his  mental  con- 
dition, disintegrating  the  systems  of  fixed  ideas  and 
recurrent  mental  states.  In  some  cases  where  the  mind 
was  paralyzed  by  the  mental  state  or  when  his  mental 
processes  were  so  warped  as  to  make  the  patient  think 
in  one  direction,  the  thoughts  should  be  directed  on 
normal  lines.  The  patient  should  be  made  interested 
in  various  mental  processes  and  logical  activities,  in 
studies  and  in  all  kinds  of  subjects  in  which  the  intelli- 
gence becomes  strengthened  and  the  mind  can  think 
on  sound  lines,  while  at  the  same  time  getting  informa- 
tion that  gradually  helps  indirectly  to  disintegrate 
the  pathological  mental  systems. 

Sometimes  it  is  well  to  set  the  patient  to  do  exhaust- 
ing work  so  as  to  counteract  the  exhausting  over- 
activity of  the  fear  instinct  and  worry.  In  some  cases 
I  have  achieved  marvellous  results  when  I  suddenly 
switched  patients  from  the  so-called  Weir-Mitchell 
treatment  and  other  medical  forms  of  treatment  to  a 
life  full  of  activity  and  labor  in  the  open,  no  plays 
and  no  games,  but  real  labor  of  the  severest  type. 
These  were  cases  who  have  complained  of  cardiac  affec- 
tions, counted  their  pulse,  and  fainted  away  at  the 
least  provocation.  I  was  with  them  all  the  time,  took 
an  active  interest  in  their    labors    and    their   progress, 


General  Psychotherapeutic  Methods  359 

and  utilized  every  opportunity  to  overcome  their  fear 
and  psychopathic  worries. 

We  must,  however,  be  careful  and  watch  the  patient 
closely,  lest  he  overdoes  and  becomes  so  overfatigued 
as  to  be  incapable  of  any  work.  In  such  cases  the  fear 
instinct  returns  with  redoubled  fury.  It  is  then  hard 
for  the  physician  to  control  the  course  of  the  disease. 
The  patient  loses  courage,  may  lose  trust  in  the  physi- 
cian and  all  confidence  in  himself.  The  physician 
should  have  a  personal,  close  watch  over  the  patient's 
work  and  not  let  it  to  the  mercies  of  a  nurse  or  an 
attendant.  The  patient  should  be  in  touch  with  the 
physician  most  of  the  time.  Incase  of  any  set-back  the 
physician  should  be  on  the  spot  to  remedy  the  mischief. 
Not  until  the  patient  gains  more  or  less  confidence  in 
himself  is  it  wise  to  leave  him  to  himself.  This  is  one 
of  the  reasons  why  it  is  so  hard,  if  not  hopeless,  to  treat 
psychopathic  patients  in  the  office.  The  physician 
gives  them  the  treatment  and  does  not  see  them  until 
the  rest  of  the  day,  and  som-Ctimes  not  before  several 
days  later.  Meanwhile,  the  patient  falls  a  victim  to 
his  own  fixed  ideas  and  fear  as  well  as  to  the  influ- 
ences, coming  from  all  kinds  of  extraneous  sources. 
Above  all,  it  is  impossible  to  regulate  his  life  and  see 
that  the  directions  are  carried  out,  that  no  evil  influ- 
ence get  hold  of  the  patient  when  he  is  at  his  lowest 
and  needs  the  help  of  a  strong  hand.  Unremittent 
vigilance  is  the  price  of  the  cure. 

Among  psychopathic  patients  may  be  found  some 
who  are  really  overworked,  and  who,  in  addition  to 
their  psychopathic  state,  actually  suffer  from  over- 
fatigue. In  such  cases  one  has  to  be  careful  not  to 
set  them  hard  tasks  and  bring  about  a  still  worse  con- 
dition of  fatigue.  Such  patients  need  rest,  though 
not  the  Weir-Mitchell's  rest  or  the  rest  and  seclusion 
advocated  by  Dejerine  and  other  French  netirologis  ts 


360     Causation  and   Treatment,   Psychopathic  Diseases 

The  seclusion  method  is  not  only  detrimental  to  the 
patients,  but  it  is  also  a  matter  of  extreme  cruelty,  it 
savors  of  the  prison  and  solitary  confinement.  The 
seclusion  treatment  should  by  all  means  be  avoided  in 
psychopathic  cases. 

Active  employment  has  been  of  late  overworked. 
Many  people  who  are  not  medical  and  know  nothing 
of  the  complexity  of  psychopathic  cases  have  under- 
taken the  treatment  of  psychopathic  patients  by  means 
of  athletic  exercises  and  other  rough  games.  Nothing 
is  further  from  the  actual  needs  of  such  patients.  In 
many  cases  such  treatment  is  doing  positive  harm. 
It  is,  therefore,  to  be  greatly  regretted  that  even  the 
medical  man  seems  to  be  under  this  delusion  of  athletics 
as  a  remedy,  and  sends  patients  to  such  establishments 
where  incalculable  mischief  is  done.  In  some  cases  the 
patient  comes  to  such  places  of  his  own  accord,  having 
heard  that  many  others  are  sent  there  by  reputable 
physicians,  or  because  some  notorious  men  have 
visited  the  place  and  have  given  it  a  good  advertise- 
ment. There  are  cases  that  suffer  from  some  cardiac 
trouble;  such  rough  treatment  is  apt  to  cause  damage 
often  of  a  dangerous  character.  Even  in  cases  where 
the  physician  examines  the  patient  for  cardiac  affection 
before  the  patient  goes  to  such  athletic  places,  there  is 
still  the  danger  of  overworking  the  patient  who  should 
be  handled  with  care  and  given  enough  to  do  without 
drawing  on  his  exhausted  store  of  energy. 

There  are  psychopathic  patients  who  suffer  from 
cerebral  fatigue.  In  such  cases  we  need  to  give  just 
enough  work  and  occupation  for  the  over-coming  of  the 
neurosis,  and  for  the  normal  functioning  of  the  body 
and  mind.  We  must,  however,  be  careful  not  to  over- 
work such  patients.  I  have  seen  many  a  patient  who 
came  to  me  under  treatment  after  he  had  gone  through 
a  strenuous  athletic  or  occupational  treatment.  I  have 


General  Psychotherapeutic  Methods  361 

found  such  patients  in  deplorable  condition.  We  must 
remember  that  cerebral  fatigue  may  often  be  associated 
with  psychoneurosis  or  with  psychosomatic  disturb- 
ances. When  cerebral  fatigue  is  present,  we  must  be 
extremely  careful  with  our  regime  of  physical  activi- 
ties, exercises,  and  occupations.  Without  appealing 
to  clinical  experience  and  psycho-therapeutic  practice 
experimental  physiology  warns  us  against  such  a  course 
of  reckless  and  inconsiderate  treatment.  I  quote  from 
Mosso  on  the  subject: 

"  Cerebral  fatigue  diminishes  the  force  of  the  muscles, 
and  with  the  ergograph  we  measure  this  phenomenon 
with  exactitude.  The  need  of  rest  after  intense  brain 
work  arises  then  from  the  fact  that  the  nervous  centers 
are  exhausted  and  the  muscles  weakened.  The  feeling 
of  discomfort  and  the  prostration  which  characterize 
intellectual  fatigue  are  due  to  the  fact  that  the  brain, 
which  is  already  exhausted,  has  to  send  stronger  stimuli 
to  the  muscles  in  order  to  make  them  contract.  The 
exhaustion  is  twofold:  central  and  peripheral.  This 
explains  why  after  brain  fatigue  one  feels  one's  energy 
exhausted  by  the  slightest  movement,  and  why  every 
obstacle  which  we  have  to  overcome  seems  to  have 
grown  more  serious.  In  these  circumstances  violent 
exercises  should  be  avoided,  because  they  are  injurious: 
fencing,  gymnastics,  or  any  muscular  effort  whatever 
aggravates  the  conditions  of  the  organism. 

"It  is,  therefore,  a  physiological  error  to  interrupt 
lessons  to  make  children  do  gymnastics  in  the  hope 
that  this  may  diminish  brain  fatigue.  To  restore  the 
forces  of  the  organism  when  exhausted  by  intellectual 
labor  there  is  no  remedy  other  than  immobility  and 
letting  one's  thoughts  wander.  When  we  force  the 
nervous  system  to  muscular  after  cerebral  effort,  we 
find  the  muscles  less  fit  for  work;  and  we  add  to  the 
cerebral  fatigue  another  fatigue  which,  as  we  shall  see 


362     Causation  and   Treatment,  Psychopathic  Diseases 

later,  is  of  the  same  nature  and  is  equally  harmful  to 
the  nervous  system.  The  best  way  to  rest  is  to  sit  still 
and  'think  of  nothing,'  and  to  let  children  play  about 
and  amuse  themselves  in  the  open  air." 

In  the  case  of  psychopathic  patients  it  is  not  desirable 
that  they  should  sit  still  all  the  time,  any  more  than  it 
is  desirable  that  children  in  school  should  all  the  time 
sit  still.  It  is  requisite  that  periods  of  activity  should 
alternate  with  periods  of  repose.  There  are  cases  where 
I  have  to  graduate  the  periods  of  work  and  regulate 
carefully  the  periods  of  repose.  Each  case,  of  course, 
should  be  treated  individually  on  its  own  merits. 
Cases  complicated  with  fear  fatigue  must  be  handled 
with  care,  and  special  conditions  should  be  arranged 
for  periods  of  work. 

For  this  purpose  of  inducing  repose  hypnoidization,  or 
the  induction  of  the  hypnoidal  state,  is  specially  calcu- 
lated to  help  in  the  treatment  of  psychopathic  maladies. 
From  a  psychognostic  standpoint  the  hypnoidal  state 
is  of  great  value,  and  it  is  of  no  less  value  from  a  psycho- 
therapeutic standpoint. 


CHAPTER  XVIII 

THE  METHOD  OF   HYPNOIDIZATION 

MANY  years  ago  I  discovered  a  special  nor- 
mal, mental  state,  widely  different  from 
the  hypnotic  state.  I  termed  the  state 
hypnoidal  and  the  method  of  its  induction 
I  termed  hypnoidization.  The  hypnoidal  state  is  of  the 
utmost  consequence  in  the  study,  psychognosis,  and 
treatment  of  functional,  psychopathic  maladies.  I  wish 
to  attract  the  attention  of  the  medical  profession  in 
general  and  of  the  student  of  Psychopathology  in 
particular  to  this  method,  which  is  not  only  of  theoreti- 
cal significance  in  psychognosis  of  the  cases,  but  is  also 
of  practical,  therapeutic  value. 

The  term  hypnoidal  and  hypnoidization  are  rather 
misleading  and  awkward  as  they  are  apt  to  convey  the 
meaning  of  something  hypnotic  or  hypnoid,and  so  on. 
We  must  warn  the  student  beforehand  against  such 
confusion  with  any  hypnosis,  light  or  otherwise.  The 
hypnoidal  state  is  a  state  sui  generis  and  is  widely 
different  from  hypnosis.  The  hypnoidal  state,  according 
to  my  researches  on  various  representatives  of  animal 
life,  is  essentially  a  sleep  state.  Subwaking  and  twilight 
state  are  more  appropriate  terms  and  indicate  more 
accurately  the  real  nature  of  the  hypnoidal  state. 
Hypnosis  is  an  abnormal  condition  while  the  subwaking, 
twilight  hypnoidal  state  belongs  to  the  normal  sleep 
states.  In  fact,  according  to  my  work,  sleep  is  a  late 
development  in  the  course  of  evolution.  Sleep  developed 
out  of  the  hypnoidal  state.  The  hypnoidal  state  is  the 
primordial  sleep  of  all  the  lower  representatives  of 
animal  life.     The  hypnoidal  state  is  really  the  funda- 

363 


364     Causation  and   Treatment,  Psychopathic  Diseases 

mental  sleep  state,  and  may  be  regarded  as  more 
normal  than  physiological  sleep  states.  We  should 
not  confuse  the  hypnoidal  state  with  light  hypno- 
sis since  the  two  are  totally  and  fundamentally 
different  in  character  and  in  nature.  Light  hyp- 
nosis is  no  more  hypnoidal  than  syncope  and  coma 
of  apoplexy  and  concussion  are  like  normal  physio- 
logical sleep.  The  hypnoidal  state  is  essentially  a 
primitive  sleep  state,  a  state  of  rest,  repose,  and  relaxa- 
tion. 

There  is  nothing  rigid  about  the  method  of  hypnoidiza- 
tion.  The  method  is  quite  elastic  and  adaptable  to 
each  person,  it  admits  of  an  almost  infinite  variety  of 
modification.  The  principal  object  is  to  observe  the 
conditions  requisite  for  the  induction  of  normal  and 
abnormal  suggestibility.  The  conditions  of  normal 
suggestibility    should    be    specially  observed. 

I  quote  the  tables  of  normal  and  abnormal  suggesti- 
bility as  well  as  the  few  laws  formulated  by  me  in  my 
work  "The  Psychology  of  Suggestion'^' 


I. 

2. 

3- 
4- 

S- 

6. 
7- 

Normal  Suggestibility. 

Fixation  of  attention. 

Distraction. 

Monotony. 

Limitation  of  voluntary  move- 
ments. 

Limitation  of  the  field  of  con- 
sciousness. 

Inhibition. 

Immediate  execution  of  the 
suggestion. 

I. 

2. 
3- 
4- 

S- 

6. 
7- 

Abnormal  Suggestibility. 
Fixation  of  attention. 

Monotony. 

Limitation  of  voluntary  move- 
ments. 

Limitation  of  the  field  of  con- 
sciousness. 

Inhibition. 

In  the  same  work  I  come  to  the  conclusion,  as  the 
result  of  investigation,  that  "the  nature  of  abnormal 
suggestibility  is  a  disaggregation  of  consciousness,  a 
slit,  a  scar,  produced  in  the  mind  that  may  extend  wider 
and  deeper,  ending  at  last  in  a  total  disjunction  of  the 
waking,   guiding,   controlling   consciousness   from   the 


The  Method  of  Hypnoidization  365 

reflex  consciousness.  .  .  .  Normal  suggestibility 
is  of  like  nature, — it  is  a  cleft  in  the  mind,  only  here  the 
cleft  is  not  so  deep,  not  so  lasting,  as  it  is  in  hypnosis 
or  in  the  state  of  abnormal  suggestibility;  the  split  is 
here  but  momentary,  evanescent,  fleeting,  disappearing 
at  the  very  moment  of  its  appearance." 

We  have  also  shown  that  the  laws  of  normal  and 
abnormal  suggestibility  may  be  stated  as  follows: 

^^  Normal  suggestibility   varies  as  indirect  suggestion 
and  inversely  as  direct  suggestion. 

^^ Abnormal  suggestibility   varies  as  direct  suggestion 
and  inversely  as  indirect  suggestion.^^ 
The  general  law  of  suggestibility  is: 
^^Suggestibility   varies   as   the   amount   of  disaggrega- 
tion, and  inversely  as  the  unification  of  consciousness. " 

It  is  on  those  general  laws  and  the  nature  of  relation 
of  the  personal  consciousness  to  the  subconscious  that 
I  have  based  my  method  of  hypnoidization.  In  order 
to  reach  the  dissociated  mental  states  we  have  to  lay 
bare  the  subconscious,  and  this  can  be  eflFected  by  the 
conditions  requisite  for  the  induction  of  normal  or  ab- 
normal suggestibility,  conditions  which  bring  about  a 
disaggregation  of  consciousness.  In  cases,  therefore, 
where  hypnosis  is  not  practicable  and  the  subconscious 
has  to  be  reached,  we  can  effect  a  disaggregation  of 
consciousness  and  thus  produce  an  allied  subconscious 
state  by  putting  the  patient  under  the  conditions  of 
normal  suggestibility:  fixation  of  attention,  distraction, 
monotony,  limitation  of  the  voluntary  movements, 
limitation  of  the  field  of  vision,  inhibition,  and  immedi- 
ate execution. 

This  is  precisely  what  the  method  of  hypnoid- 
ization consists  in:  "The  patient  is  asked  to 
close  his  eyes  and  keep  as  quiet  as  possible,  without, 
however,  making  any  special  effort  to  put  himself  in 
such  a  state.     He  is  then  asked  to  attend  to  some 


366     Causation  and   Treatment,  Psychopathic  Diseases 

stimulus  such  as  reading  or  singing  (or  to  the  monoto- 
nous beats  of  a  metronome).  When  the  reading  is  over, 
the  patient,  with  his  eyes  shut,  is  asked  to  repeat  it  and 
tell  what  comes  into  his  mind  during  the  reading,  or 
during  the  repetition,  or  immediately  after  it.  Some- 
times the  patient  is  simply  asked  to  tell  the  nature  of 
ideas  and  images  that  have  entered  his  mind."  This 
should  be  carried  out  in  a  quiet  place,  and  the 
room,  if  possible,  should  be  darkened  so  as  not  to  dis- 
turb the  patient  and  bring  him  out  of  the  state  in  which 
he  has  been  put. 

Fatigue,  physical  and  mental,  especially  emotional, 
is  a  favorable  condition.  A  prolonged  warm  bath  with 
relaxation  is  favorable.  A  predisposition  to  sleep  is 
helpful.  It  is,  therefore,  best  to  make  the  first  attempts 
at  hypnoidization  late  at  night,  when  the  patient  is 
both  tired  and  sleepy.  In  most  cases,  darkness,  quiet- 
ness, repose,  the  monotonous  buzzing  of  an  inductorium 
are  conditions  favorable  to  the  induction  of  the  hypnoid- 
al state. 

As  modifications  of  the  same  method,  the  patient  is 
asked  to  fixate  his  attention  on  some  object  while  at 
the  same  time  listening  to  the  beats  of  a  metronome; 
the  patient's  eyes  are  then  closed;  he  is  to  keep 
quiet,  while  the  metronome  or  some  other  monotonous 
stimulus  is  kept  on  going.  After  some  time,  when  his 
respirations  and  pulse  are  found  somewhat  lowered, 
and  he  declares  that  he  thinks  of  nothing  in  particular, 
he  is  asked  to  concentrate  his  attention  on  a  subject 
closely  relating  to  the  symptoms  of  the  malady  or  to 
the  submerged,  subconscious  states. 

The  patient,  again,  may  be  asked  to  keep  quiet,  to 
move  or  change  position  as  little  as  possible,  and  is  then 
required  to  look  steadily  into  a  glass  of  water  on  a  white 
background,  with  a  light  shining  through  the  contents 
of  the  glass;  a  mechanism  producing  monotonous  sounds 


The  Method  of  Hypnoidization  367 

is  set  going,  and  after  a  time,  when  the  patient  is  ob- 
served lO  have  become  unusually  quiet,  he  is  asked  to 
tell  what  he  thinks  in  regard  to  a  subject  relating  to 
his  symptoms.  He  may  be  asked  to  write  the  stray 
ideas  down,  if  speaking  aloud  disturbs  the  induced 
states  favorable  to  the  emergence  of  the  dissociated 
mental  states. 

In  some  cases  it  is  sufficient  to  put  the  patient  in  a 
quiet  condition;  have  his  eyes  shut  and  command  him 
to  think  hard  of  the  particular  dissociated  states. 

Once  the  hypnoidal  state  is  induced  by  any  of  the 
various  methods  of  hypnoidization,  we  can  either  at- 
tempt to  follow  up  the  history  and  the  development  of 
the  malady,  or  we  may  chiefly  work  for  the  therapeutic 
effect  and  treat  the  present  symptoms.  It  is,  however, 
advisable  from  a  purely  practical  therapeutic  purpose 
to  combine  the  two  procedures,  the  cure  is  then 
effective  and  far  more  stable.  When  the  history  of  the 
origin  and  development  of  the  disease  can  not  be 
traced,  on  account  of  the  age  or  unintelligence  of  the 
patient,  the  therapeutic  effects  alone  of  the  hypnoidal 
states  have  been  utilized.  The  results  are  not  as  satis- 
factory as  far  as  scientific  information  is  concerned,  but 
they  are  of  great  benefit  to  the  patient. 

The  getting  access  to  subconscious  experiences,  lost 
to  the  patient's  personal  consciousness  makes  the 
hypnoidal  state  a  valuable  instrument  in  the  tracing  of 
the  origin  and  development  of  the  symptoms  of  the 
psychopathic  malady. 

From  a  practical  standpoint,  however,  the  thera- 
peutic value  of  the  hypnoidal  state  is  most  important. 
Our  experiments  have  revealed  to  us  the  significant 
fact  that  the  hypnoidal  state  is  the  primordial  rest- 
state;  sleep  is  but  a  derivative  form  of  rest.  In  many 
conditions  of  disease  it  is  advisable  to  have  the  patient 
revert    to    a    simple    and    primitive     mode    of     life. 


368     Causation  and  Treatment,  Psychopathic  Diseases 

Similarly,  in  psychopathic  diseases  a  reversion  to  a  simple 
primitive  state  proves  to  he  of  material  help  to  the  patient. 
In  plunging  the  patient  into  the  hypnoidal  state,  we 
have  him  revert  to  a  primitive  rest-state  with  its  con- 
sequent beneficial  results.  The  suggestibility  of  the 
state,  if  skillfully  handled,  is  apt  to  increase  the  thera- 
peutic efficacy.  Relaxation  of  nervous  strain,  rest 
from  worry,  abatement  of  emotional  excitement,  are 
known  to  be  of  great  help  in  the  treatment  of  nervous 
troubles  of  the  neurasthenic  or  of  the  so-called  "psycho- 
asthenic"  variety.  That  is  what  we  precisely  observe 
in  the  treatment  of  psychopathic  diseases  by  means  of 
the  agency  of  the  hypnoidal  state,  the  efficacy  of  which 
is  all  the  greater  on  account  of  the  presence  of  the  im- 
portant trait  of  suggestibility. 

The  most  important  fact,  however,  is  the  access 
gained  through  the  hypnoidal  state  to  the  patients  stores 
of  subconscious  reserve  neuron  energy,  thus  helping  to 
bring  about  an  association  of  disintegrated,  dissociated 
mental  systems. 

Dr.  John  Donley  in  his  article  "The  Clinical  Use  of 
Hypnoidization  "  published  in  The  Journal  of  Abnormal 
Psychology  for  August-September,  1908,  gives  the  fol- 
lowing account  of  the  method  of  hypnoidization  and 
of  the  hypnoidal  state: 

"The  treatment  of  that  large  group  of  disorders 
commonly  classed  as  the  psycho-neuroses  is  sufficiently 
arduous  to  warrant  the  assumption  of  a  receptive  mood 
toward  any  measure  that  may  increase  our  efficiency. 
Such  assistance,  it  would  seem,  is  open  to  us 
in  the  hypnoidization  of  Dr.  Boris  Sidis. 

"Hypnoidization  has  two  things  to  recommend  it, 
facility  of  induction  and  successful  results.  The 
technique  is  simple,  there  need  be  no  mention  of  hypno- 
sis, and  hence  no  stirring  up  of  apprehension  in  the 
mind  of  even   the  most  timorous   patient;  while  the 


The  Method  of  Hypnoidization  369 

effects  produced  are  comparable,  in  many  respects  at 
least,  with  those  brought  about  through  the  medium 
of  complete  hypnosis.  It  is  not,  and  perhaps  cannot 
be  maintained  that  in  hypnoidization  we  possess  a 
complete  substitute  for  hypnosis;  but  so  far  as  a  limited 
experience  (some  thirty  cases)  allows  of  our  drawing 
any  conclusions  we  feel  that  hypnoidization  is  quite 
worthy  of  more  attention  and  study  than  it  has  hither- 
to received. 

"...  Many  variations  of  this  particular  pro- 
cedure are  of  course  possible,  and  the  one  which  the 
writer  has  found  quite  generally  useful  is  the  following: 
The  patient  is  first  placed  at  ease  by  a  few  minutes' 
conversation,  during  which  he  is  instructed  regarding 
what  is  about  to  be  done.  He  is  then  requested  to  lie 
upon  the  couch,  the  head  of  which  has  been  placed  close 
to  a  faradic  wall  plate.  With  his  eyes  closed  he  is 
directed  to  listen  to  the  monotonous  vibration  of  the 
ribbon  rheotome,  and  to  concentrate  attention  either 
upon  nothing  at  all  or  upon  the  particular  idea  or  group 
of  ideas  or  images  suggested  to  him  by  the  physician. 
At  the  beginning  of  the  experiment  the  patient  may  be 
somewhat  tense  and  ill  at  ease,  but  a  few  minutes 
suffice  to  render  him  relaxed  and  to  place  him  in  the 
mental  state  to  which  Sidis  has  given  the  name  'hyp- 
noidal.'  It  is  during  the  continuance  of  this  state  that 
one  may  obtain  information  valuable  for  diagnosis?  and 
give  suggestions  useful  for  therapeusis. 

".  .  .  During  a  psychotherapeutic  conversation 
one  will  often  notice  a  certain  attitude  of  criticism  and 
resistance  upon  the  part  of  a  patient,  whereas  if  the 
same  patient  be  placed  in  the  hypnoidal  state,  there  is 
voluntary  conversation  with  the  physician,  yet  a 
greater  readiness  to  give  credence  to  his  remarks.  For 
the  purpose  of  psychotherapy  it  is  often  useful  to  place 
the  patient  in  a  condition  of  hypnoidization   during 


370     Causation  and  Treatment,  Psychopathic  Diseases 

which  a  greater  influence  may  possibly  be  exerted  upon 
subconscious  mental  processes.  There  is  then  a  more 
direct  avenue  of  approach  to  those  subconscious  factors 
that  are  so  potent  in  determining  and  influencing  self- 
conscious  attitudes;  for  it  has  seemed  to  me  that  the 
physical  and  mental  relaxation  that  characterize  the 
hypnoidal  state  are  precisely  the  conditions  requisite 
for  imprinting  ideas  upon  the  minds  of  neurotic  patients. 
Whether  and  how  far  this  is  true  will  be  determined  by 
a  wider  experience  with  different  types  of  patients. 
Some  have  been  particularly  receptive  in  hypnoidiza- 
tion,  which  they  were  not  in  the  waking  state;  others 
have  been  very  much  less  so. 

"The  beneficial  effects  of  hypnoidization  are  to  be 
seen  not  alone  in  those  cases  where  submerged,  forgotten 
memories  and  emotions  are  operative  in  the  production 
of  mental  disaggregation,  but  also  in  those  numerous 
instances  where  the  experience  causing  the  obsessive 
idea  or  emotion  is  well  known  to  the  upper  conscious- 
ness. 

".  .  .  The  mechanism  at  work  during  hypnoid- 
ization may  be  assumed  to  be  that  of  mental  synthesis 
into  the  self-conscious  personality  of  the  individual. 
With  the  production  of  this  synthesis  and  as  a  conse- 
quence of  it  there  is  a  change  of  emotional  tone.  This, 
I  believe, is  the  most  important  factor  in  the  case.  A 
mental  system  which  remains  automatic  and  extra- 
voluntary  carries  with  it  a  disturbing  emotional  reac- 
tion. In  cases  I  and  II  for  example  the  recurrence  of 
the  obsessive  state  was  not  only  accompanied,  but  pre- 
ceded and  followed  by  a  most  pronounced  emotion  of 
fear,  with  all  of  its  psychological  manifestations.  As  a 
result  of  this  the  patients  were  kept  in  a  state  of  more 
or  less  constant  psychological  disintegration.  They 
were  unable  to  master  their  emotions. 

"In  hypnoidal  states  they  were  made  to  reproduce 


The  Method  of  Hypnoidization  371 

their  obsessive  thoughts  and  images  and  then  to  describe 
them  in  words.  When  this  had  been  accompHshed  and 
they  had  received  further  assurance  and  persuasion 
from  the  experimenter,  although  the  purely  intellectual 
content  of  their  obsessions  remained  known  to  them, 
the  insistent  automatic  character  and  disturbing  emo- 
tional factors  had  disappeared.  In  this  metamorphosis 
of  emotional  reaction  we  may  observe  one  of  the  most 
interesting  and  useful  attributes  of  the  hypnoidal 
state." 

Dr.  Donley  gives  then  a  series  of  cases  which  he 
treated  successfully  from  psychognostic  and  psycho- 
therapeutic standpoints.  The  reader  is  referred  to  the 
original  article. 

I  may  also  refer  to  Dr.  Mitchell's  presidential  ad- 
dress before  the  English  Psycho-Medical  Society  on 
January  26,  191 1,  on  ^^  The  Hypnoidal  State  of  Sidis,^^ 
published  in  the  Transaction  of  the  Psycho-Medical 
Society,  and  republished  in  my  ^^Symptomatology." 
"The  value  of  hypnoidization,"  says  Dr.  Mitchell, 
"in  the  resurrection  of  dissociated  memories  is  that 
which  is  perhaps  best  established.  And  this  applies 
not  only  to  the  restoration  of  the  forgotten  experiences 
of  ordinary  amnesia,  but  to  the  recovery  of  dissociated 
memories  that  are  of  pathogenic  significance.  .  . 
Sidis  himself  has  insistently  taught  that  the  reassocia- 
tion  of  dissociated  complexes  effects  a  cure  of  psycho- 
pathic disease.  .  .  My  own  experience,  so  far  as  it 
goes  tends  to  corroborate  in  every  respect  the  claims 
put  forward  by  Sidis.     .     ." 

While  in  the  hypnoidal  state  the  patient  hovers 
between  the  conscious  and  the  subconscious,  somewhat 
in  the  same  way  as  in  the  half-drowsy  condition  one 
hovers  between  wakefulness  and  sleep.  The  patient 
keeps  on  fluctuating  from  moment  to  moment,  now 
falling  more  deeply  into  a  subconscious  condition  in 


372     Causation  and  Treatment,  Psychopathic  Diseases 

which  outlived  experiences  are  easily  aroused,  and 
again  rising  to  the  level  of  the  waking  state.  Experi- 
ences long  submerged  and  forgotten  rise  to  the  full  light 
of  consciousness.  They  come  in  bits,  in  chips,  in  frag- 
ments, which  may  gradually  coalesce  and  form  a  con- 
nected series  of  interrelated  systems  of  experiences 
apparently  long  dead  and  buried.  The  resurrected 
experiences  then  stand  out  clear  and  distinct  in  the 
patient's  mind.  The  recognition  is  fresh,  vivid,  and 
instinct  with  life,  as  if  the  experiences  have  occurred 
the  day  before. 

It  cannot  be  insisted  too  much  that  the  hypnoidal 
state  is  not  a  light  hypnosis.  The  hypnoidal  state  is  a 
sleep  state.  The  hypnoidal  state  is  the  anabolic  state  of 
repose  characteristic  of  primitive  life. 

The  hypnoidal  state  is  an  intermediary  state  between 
waking  and  sleep.  Subwaking  is  an  appropriate 
descriptive  term  of  the  character  of  the  hypnoidal  state. 
The  subwaking  hypnoidal  state,  like  sleep  and  hypnosis, 
may  be  of  various  depth  and  duration;  it  may  range 
from  the  fully  waking  consciousness  and  again  may 
closely  approach  and  even  merge  into  sleep  or  hypnosis. 
The  same  patient  may  at  various  times  reach  different 
levels,  and  hence  subconscious  experiences  which  are 
inaccessible  at  one  time  may  become  revealed  at  some 
subsequent  time,  when  the  patient  happens  to  go  into 
a  deeper  hypnoidal  state. 

On  account  of  the  instability  of  the  hypnoidal  state, 
and  because  of  the  continuous  fluctuation  and  varia- 
tion of  its  depth,  the  subconscious  dissociated 
experiences  come  up  in  bits  and  scraps,  and  often 
may  lack  the  sense  of  familiarity  and  recognition.  The 
patient  often  loses  the  train  of  subconscious  associa- 
tions; there  is  a  constant  struggle  to  maintain  this 
highly  unstable  hypnoidal  state,  and  one  has  again  and 
again  to  return  to  the  same  subconscious  train  started 


The  Method  oj  Hypnoidization  373 

into  activity  for  a  brief  interval  of  time.  One  must 
pick  his  way  among  streams  of  disturbing  associations 
before  the  dissociated  subconscious  experiences  can  be 
synthesized  into  a  whole,  reproducing  representatively 
the  original  experience  that  has  given  rise  to  the  whole 
train  of  symptoms. 

The  hypnoidal  state  may  sometimes  reproduce  the 
original  experience  which,  at  first  struggling  up  in  a 
broken,  distorted  form  and  finally  becoming  synthesized, 
gives  rise  to  a  full  attack.  The  symptoms  of  the  mal- 
ady turn  out  to  be  portions,  bits,  and  chips  of  past 
experiences  which  have  become  dissociated,  giving 
rise  to  a  disaggregated  subconsciousness.  The  method 
of  hypnoidization  and  the  hypnoidal  states  induced  by 
it  enable  us  to  trace  the  history  and  etiology  of  the  sym- 
ptoms, and  also  to  effect  a  synthesis  and  a  cure. 

For  many  years  my  investigations  of  the  hypnoidal 
state  were  carried  out  on  subjects  and  patients,  adults 
and  children.  The  work  was  entirely  limited  to  the 
study  of  such  states  as  found  in  man.  Having  found 
that  during  the  hypnoidal  state  the  condition  of  mental 
plasticity  is  quite  pronounced  for  therapeutic  purposes, 
and  having  effected  many  cures  of  severe  psycho- 
pathic maladies,  ranging  throughout  the  whole  domain 
of  so-called  hysterical  affections,  neurasthenia,  obses- 
sions, drug  habits,  especially  alcoholic  ones,  the  hyp- 
noidal state  has  become,  in  my  practice,  quite  an 
important  therapeutic  agent.  Lately,  others  have  ob- 
tained excellent  results  with  the  hypnoidal  state  in 
their  treatment  of  various  functional,  psychopathic 
maladies. 

The  theraupeutic  employment  of  the  hypnoidal  state 
may  be  accomplished  in  a  physiological  mode  or  in  a 
purely  psychological  way.  The  hypnoidal  state  may 
be  utilized  for  the  induction  of  an  intermediate  sleep 
State  of  repose,  in  accord  with  its  proper  function  in  the 


374     Causation  and  Treatment,  Psychopathic  Diseases 

early  history  of  animal  life  when  rest  was  requisite  for 
repair  of  organ  and  function.  The  psychological  mode 
is  the  utilization  of  the  hypnoidal  state  for  the  direct 
and  indirect  mental  modification  of  the  psychopathic 
mental  systems.  The  alternation  of  the  two  forms  of 
hypnoidal  treatment  is  sometimes  advisable.  In  a 
number  of  cases  the  repose  hypnoidal  treatment,  if 
supplemented  by  other  methods,  is  quite  effective. 

I  have  pointed  out  that  the  conditions  of  abnormal 
suggestibility  are:  (i)  Fixation  of  attention;  (2)  monot- 
ony; (3)  limitation  of  voluntary  movements;  (4)  limita- 
tion of  the  field  of  consciousness;  (5)  inhibition. 

Patients,  therefore,  who  are  so  situated  as  not  to 
comply  with  the  conditions  of  abnormal  suggestibility 
are  difficult  to  hypnotize.  Patients  whose  attention 
is  weak,  fluctuating  and  wandering,  who  cannot  sus- 
tain any  interest  in  a  subject  without  changing  it  im- 
mediately; patients  with  diffused  attention,  such  as 
idiots,  imbeciles,  are  not  favorable  subjects  for  hypno- 
tization.  On  the  other  hand,  patients  whose  per- 
sonal attention  is  fixed  on  systematized  delusions, 
fixed  ideas,  imperative  concepts  or  on  any  other  well- 
organized  system  of  ideas  permeated  by  a  strong  emo- 
tion, patients  who  are  intensely  conscious  of  their 
troubles  and  pay  minute  attention  to  the  slightest 
symptoms  so  that  their  attention  is  confined  to  a  nar- 
row, limited  region,  their  ideas  and  concepts  are  fixed, 
their  mental  and  emotional  activities  run  in  well-defined 
grooves  which  resist  efforts  at  variations, — such  patients 
are  hard  to  put  into  a  hypnotic  state.  The  whole  men- 
tal make-up  has,  in  such  patients,  not  only  lost  its 
plasticity,  but  is  militantly  aggressive,  so  to  say, 
against  all  changes,  the  dominant  mental  systems 
having  gained  undue  control  over  the  personal  conscious- 
ness of  the  individual.  The  attention  is  already  bound 
in  one  definite  direction,  in  the  direction  of  the  pre- 


The  Method  of  Hypnoidization  375 

dominant  systems  which  admit  of  no  inhibition.  Thus 
free  fixation  of  attention  and  voluntary  inhibition,  the 
two  important  conditions  requisite  for  abnormal  sug- 
gestibility, are  here  at  a  disadvantage  or  completely 
absent. 

Patients  with  a  shifting  attention,  as  well  as 
patients  with  a  more  or  less  rigidly  fixed  attention,  are 
usually  poor  hypnotic  subjects  and  are  specially  bene- 
fited by  the  hypnoidal  state.  Patients  with  insistent 
moods  of  a  depressing  character,  with  a  fixed  tendency 
to  worry,  to  inspect  the  minutiae  of  feelings,  hovering  in 
the  background  of  consciousness;  patients  who  take 
delight  in  self-analysis,  in  watching  their  symptoms, 
who  never  can  dilate  enough  on  the  various  delicate 
shades  of  their  feelings  and  experiences;  patients  whose 
focal  consciousness  seems  always  to  hover  with  a  feeling 
of  luxury  on  the  periphery  of  mental  life, — such  patients 
are  often  the  despair  of  the  physician  who  should  avail 
himself  of  the  hypnoidal  state,  specially  adapted  for 
such  cases.  The  hypnoidal  state  may  not  be  strik- 
ing and  sensational  in  its  manifestations,  but  it  is  a 
powerful  instrument  in  Psychopathology  and  Psycho- 
therapeutics. 


CHAPTER  XIX 

CLINICAL     CASES     OF     HYPNOIDAL     TREATMENT 
I. 

MR.  M.  G.  Irish.  Age  thirty-eight.  Mar- 
ried. Occupation,  liquor  dealer.  Father, 
living,  well.  Mother  died  of  pneumonia 
when  at  the  age  of  forty.  Brother  and 
sister  died  of  some  obscure  form  of  "heart  trouble." 
Physical  condition  is  good.  Patient  has  no  appetite, 
worries,  has  no  confidence  in  himself,  is  full  of  indecision 
and  fear  of  anything  "new;"  he  is  extremely  methodi- 
cal, things  must  be  arranged  in  a  certain  order,  otherwise 
he  feels  uneasy  and  quite  unhappy.  Has  no  head- 
aches, suffers  from  insomnia.  Does  not  drink,  but 
smokes  excessively.  Sexual  life  normal.  Has  been 
sensitive  and  nervous  from  his  very  childhood.  He 
broods  much  over  his  incapacity  of  spelling.  Has  been 
lately  working  very  hard  on  a  new  business  intrusted 
to  his  care.  He  doubts  his  business  capacities,  and 
fears  to  ruin  the  business.  He  became  greatly  de- 
pressed, had  to  give  up  his  work  and  go  to  the  country, 
but  with  no  beneficial  results. 

The  patient  was  brought  to  me  in  a  state  of  deep 
despondency,  close  on  the  brink  of  suicide.  He  could 
not  be  hypnotized.  I  put  him  into  a  slight  hyp- 
noidal  state,  and  kept  him  in  a  state  of  relaxation  for 
fifteen  minutes  to  half  an  hour.  When  he  came  out  of 
it  he  felt  "a  little  better,  but  not  much."  After  two 
weeks'  treatment  the  patient  felt  so  far  improved  that 
I  advised  him  to  return  to  his  work  while  his  treatment 
was  being  continued.  Gradually  his  despondency  gave 
way;  his  fears,  worries,  and  doubts  disappeared,  while 
confidence  in   himself  became   strengthened.     Patient 

376 


Clinical  Cases  of  Hypnoidal  Treatment  2)77 

declared  he  felt  well, — "  never  felt  so  well "  before.  The 
treatment  covered  a  period  of  three  months.  It  is  now 
more  than  seven  years  since  the  completion  of  the  cure, 
the  patient  continues  to  stay  well  and  carries  on  his 
business  with  far  more  energy  than  before. 

II.  Miss  P.  R.  Age  twenty-three.  American. 
Mother  is  nervous,  "hysterical."  Sister  high  strung. 
Patient  was  "sensitive"  when  young,  but  was  well 
otherwise.  Her  present  trouble  began  some  three 
years  ago.  She  suffers  from  constipation,  nausea 
vomiting,  dizziness,  dysmenorrhea.  Eyes  ache  occa- 
sionally and  are  relieved  by  glasses.  Suffers  from 
numbness  in  extremities  and  great  fatigue.  Attention 
is  good,  but  her  mental  state  is  one  of  indecision  and 
fear. 

At  first  the  hypnoidal  state  was  brief  in  duration, 
the  patient  being  restless,  but  as  I  persisted,  the  hyp- 
noidal state  became  prolonged,  with  gradually  increas- 
ing beneficial  effects. 

III.  B.  P.  Seventeen  years  of  age.  Family  history 
is  good.  Up  to  the  age  of  twelve  was  well.  After  that 
he  changed  in  character,  became  irascible,  deceptive  in 
his  dealings  with  people,  careless  in  his  social  relations, 
contradicted  and  even  abused  occasionally  his  relatives 
and  treated  his  mother  with  disrespect.  All  power  of 
concentration  of  attention  seemed  to  have  gone, — at 
least  he  claimed  so.  "My  head  begins  to  whirl  and 
my  eyes  darken  when  I  get  hold  of  a  book  and  try  to 
think  long."  The  boy  probably  exaggerated  his  con- 
dition, but  he  was  tested  in  various  ways  by  different 
physicians  and  educators,  and  his  attention  was  found 
to  be  wandering.  The  boy  was  otherwise  quite  intelli- 
gent. He  became  associated  with  idle  boys,  learned 
to  smoke  and  acquired  other  bad  habits.  About  the 
age  of  fourteen,  he  met  with  an  accident  from  a  cannon 


378     Causation  and   Treatment,  Psychopathic  Diseases 

cracker,  which  knocked  him  down  unconscious  and 
nearly  destroyed  his  eyesight. 

The  treatment  of  the  case  is  quite  complicated  and 
would  take  too  much  space  to  elucidate  it  here.  I  can 
only  say  that  the  hypnoidal  state  has  been  utilized  in 
this  case  with  great  advantage.  Besides  the  thera- 
peutic power  of  the  hypnoidal  state,  the  subconscious 
reserve  nervous  energy  comes  into  play,  while  many  of 
the  other  psychotherapeutic  methods  become  enhanced 
in  their  efficiency  when  utilized  in  the  subwaking 
hypnoidal  condition. 

IV.  Mrs.  F,  T.  Age  twenty-seven.  American. 
Family  history  good.  Patient  is  emaciated,  pale  and 
anemic;  pulse  is  irregular;  there  is  accentuation  of 
second  aortic;  otherwise  heart  is  in  good  condition. 
Menstruation  is  normal,  occasionally  painful  and  scan- 
ty. She  was  well  when  a  child,  but  was  delicate 
and  frail.  She  studied  hard  in  one  of  the  local  acad- 
emies and  got  a  fair  education.  In  the  provincial 
town  where  she  lived  things  were  quiet,  and  pa- 
tient's life  was  rather  uneventful  up  to  the  time 
of  her  marriage,  about  the  age  of  twenty-two.  She 
was  then  suddenly  transferred  from  a  quiet  environ- 
ment right  into  the  turmoil  and  whirl  of  life.  The 
young  couple  had  a  hard  struggle  for  the  bare  necessities 
of  life;  at  the  same  time  the  family  responsibilities  and 
social  duties  were  heavy,  exacting,  and  distasteful.  This 
told  on  the  patient  and  she  began  to  brood,  became 
gloomy,  depressed,  lost  her  appetite,  began  to  suffer 
from  restless  sleep  accompanied  with  bad  dreams  and 
nightmares;  complained  of  anorexia,  indigestion,  nausea, 
retching,  headaches,  and  dysmenorrhea.  Darkness  be- 
gan to  gather  around  her  and  she  began  to  feel,  as  if 
she  were  hemmed  in  by  dark  shadows  which  haunted 
her  day  and  night.  Her  dreams  were  full  of  the  same 
"indefinable  shadows  which  have  gotten  a  grip  on  her 


Clinical  Cases  of  Hypnoidal  Treatment         379 

life  and  sucked  out  the  essence  of  her  soul."  She  used 
to  wake  with  those  shadows,  crowding  on  her  from  all 
sides.  The  patient,  in  short,  was  obsessed  by  a  fear 
of  shadows.  She  was  tired  at  the  least  exertion,  could 
not  concentrate  her  mind,  had  no  self-control,  no  will- 
power to  decide  anything,  life  was  a  burden. 

Patient  was  treated  by  hypnoidization.  The  physical 
and  mental  conditions  began  to  improve  rapidly.  All 
the  gloom  and  shadows  fled.  The  fatigue,  the  head- 
aches, the  digestive  and  menstrual  disturbances  were 
gone,  and  at  the  end  of  four  months  she  recovered  her 
health  and  cheerfulness,  and  gained  twenty-three 
pounds  in  weight.  It  is  now  more  than  ten  years 
since  the  treatment  is  completed;  patient  continues 
in  excellent  condition. 

V.  Miss  E.  F,  Age  twenty-five.  American  of 
Irish  descent.  Family  history  is  good.  Physical  con- 
dition is  good;  menstruation  normal.  She  was  well 
up  to  the  age  of  seventeen,  when  during  the  winter  she 
had  a  severe  attack  of  the  grippe.  She  suffered  from 
insomnia.  It  happened  that  a  lady,  a  neighbor  of 
theirs,  became  insane.  The  idea  then  came  to  the 
patient's  mind  that  she  too  might  become  insane. 
Filthy  words  enter  her  mind,  and  she  feels  as  if  she  "is 
getting  crazy."  Another  source  of  worry  is  her  nose 
which  seems  to  her  not  to  be  shapely  enough.  She  feels 
greatly  depressed  and  life  is  a  burden  to  her.  She  has 
frightful  nightmares,  dreams  of  dead  people,  especially 
of  the  insane  woman.  At  day  time  she  keeps  on  think- 
ing of  the  insane  woman.  - 

A  prolonged  stay  in  th?  hypnoidal  state  made  the 
patient  feel  happy  immediately  after  the  first 
treatment.  The  effect  wore  off  after  a  day.  A  few 
more  treatments  made  patient  feel  well  and  comfort- 
able. 

VI.  J.    R.     Male.     American.     Age    twenty-eight. 


380     Causation  and   Treatment,  Psychopathic  Diseases 

Family  history  as  far  as  it  could  be  ascertained  is  good. 
Occupation,  artist.  He  has  strong  homosexual  ten- 
dencies. Th  sexual  instinct  for  women  is  completely 
absent.  A  big  man  with  immense  hips  is  his  ideal  of 
sexual  desire.  His  mind  is  full  of  images  of  males  in 
various  lascivious  postures.  The  images  disturb  him 
much,  so  that  he  cannot  carry  on  his  work.  When  he 
comes  in  contact  with  men  of  the  same  inclinations  he 
becomes  excited.  In  his  dreams  he  sees  men  who 
excite  him  and  respond  to  his  sexual  passions.  His 
mental  and  physical  conditions  are  otherwise  quite 
good,  and  he  is  doing  work  which  is  regarded  to  be  of 
high  grade. 

In  the  hypnoidal  state  it  came  to  light  that  at  the  age 
of  fifteen  he  carried  on  a  love  affair  with  a  room  mate 
of  his  with  whom  he  slept  in  the  same  bed.  He  always 
liked  to  play  with  boys,  and,  if  possible,  sleep  with  them 
in  the  same  room.  This  he  succeeded  in  accomplish- 
ing a  number  of  times.  Far,  far  away  back  in  his 
childhood  perhaps  at  the  age  of  six,  he  was  influ- 
enced by  a  big  coachman  who  induced  him  to  carry 
out  homosexual  practices.  It  was  the  aspect  of  that 
coachman  that  became  with  the  patient  the  main 
object  of  his  sexual  passions.  This  incident  was  always 
hovering  in  his  mind,  although  he  did  not  remember  it 
so  distinctly  as  in  the  hypnoidal  state. 

A  series  of  treatments  by  means  of  the  hypnoidal 
state  relieved  the  patient  of  his  homosexual  passions. 
The  patient  was  not  long  enough  under  treatment  to 
cultivate  his  degenerated  or  rather  rudimentary  nor- 
mal sexual  instinct.  This  gave  rise  to  some  unpleasant 
complications  into  which  I  cannot  enter  here.  The 
patient  was,  however,  entirely  freed  from  his  homo- 
sexuality. 

VII.  H.  R.  Male.  Age  twenty-six.  Occupation, 
engineer.     Father  suffers  from  heart  trouble;  mother 


Clincial  Cases  of  Hypnoidal  Treatment  381 

died  of  some  tubercular  affection.  Patient  was  operat- 
ed for  hydrocele  and  tubercular  testicle  some  five  years 
ago.  He  feels  physically  and  mentally  well,  but  is 
possessed  by  homosexuality.  He  can  trace  the  homo- 
sexuality to  his  fourteenth  year.  It  is  not,  however, 
the  homosexual  desires  that  trouble  him,  because  they  are 
weak;  it  is  rather  the  absence  of  the  heterosexuality 
that  worries  him,  he  wants  to  get  married  and  have 
a  good  family  life.  He  loves  children  and  wishes  to 
have  some  of  his  own.  Any  attempt  on  the  part  of  the 
patient  to  cultivate  heterosexuality  meets  with  complete 
failure.  He  has  no  desire  for  women;  in  fact,  he  even 
experiences  a  dislike  for  them.  He  masturbates  occa- 
sionally. The  images  which  fill  his  imagination  during 
the  act  of  masturbation  are  entirely  of  a  homosexual 
character. 

The  treatment  was  of  rather  short  duration,  about 
a  few  weeks  in  all,  and  the  hypnoidal  state  could  not  be 
prolonged  sufficiently  to  enable  me  to  penetrate  into 
the  patient's  subconscious  life  and  trace  the  origin  and 
development  of  the  homosexuality.  The  hypnoidal 
state,  however,  enabled  me  to  free  him  fro  his  homo- 
sexuality and  to  arouse  in  him  an  interest  for  the  other 
sex. 

VHI.  Mrs.  T.  D.  Age  forty-iive.  American.  Mar- 
ried. Father  well.  Mother  died  of  some  unknown 
disease  at  the  age  of  twenty-five.  One  sister  nervous, 
the  other  died  of  tuberculosis.  Patient  was  a  precocious 
child  and  extremely  nervous.  About  the  age  of  four- 
teen had  typhoid  fever;  began  to  menstruate  about  the 
age  of  thirteen.  At  the  age  of  sixteen  entered  a  milli- 
nery store  and  at  twenty  became  a  modiste.  She  was 
then  strong,  healthy,  vivacious,  and  enjoyed  life.  She 
had  many  admirers  and  finally  got  married  at  the  age 
of  twenty-five.  After  a  few  years  of  married  life  she 
became  nervous,  restless,  suffered  from  headache,  back- 


382     Causation  and   Treatment,  Psychopathic  Diseases 

ache,  constipation  and  loss  of  appetite.  She  lost  flesh, 
from  one  hundred  and  forty-five  she  went  down  to 
one  hundred  and  twenty  pounds.  Menopause  set  in  at 
the  age  of  forty-two.  She  has  been  for  some  time  under 
the  care  of  a  physician  and  has  Improved  a  little.  She 
did  not  come  to  me,  however,  for  her  physical  troubles, 
as  she  found  that  they  really  were  of  little  conse- 
quence. "The  whole  trouble  is  mental.  If  you  could 
only  help  me,  I  would  make  a  clean  breast  of  it.  It 
has  come  now  to  a  point  that  I  need  help. " 

She  has  no  children,  no  responsibilities,  selfish,  full 
of  fears  about  self;  she  is  disappointed  in  her  husband. 
Sexual  relations  have  been  normal.  Recently  she  met 
a  young  married  man  with  whom  she  fell  in  love 
as  a  distraction  and  stimulation  in  a  life  of  dull,  monot- 
onous selfishness  and  fear.  She  is  conscious  that  the 
whole  thing  is  foolish,  sentimental;  moreover,  the  man 
is  unworthy.  She  needs  help  to  get  rid  of  that  ob- 
session. "Life  is  not  worth  living."  The  patient  is 
deeply  depressed. 

Patient  was  quieted  by  a  little  talk  a'  d  then  put  into 
the  relaxation  characteristic  of  the  hypnoidal  state.  At 
first  she  was  restless  and  fidgety,  but  she  gradually  be- 
came quiet  and  relaxed.  When  she  came  out  of  the 
hypnoidal  state  she  was  quiet,  composed  and  felt  more 
self-control.  After  a  few  treatments,  the  patient  felt 
considerably  better,  the  fixed  idea  or  insistent  emotion 
lost  its  grip  and  she  regained  her  self-possession. 

IX.  Mrs.  B.  F.  Age  thirty-eight.  American.  Oc- 
cupation, physician.  Patient  comes  of  neuropathic 
stock.  Both  parents  were  highly  neurotic.  One  of  the 
brothers  committed  suicide.  As  a  child,  patient  was 
sensitive  and  nervous,  suffered  from  various  fears. 
At  the  age  of  eight  she  had  a  bad  fall,  with  unconscious- 
ness. As  a  young  girl  she  worked  hard,  but  felt  well. 
The  first  period  after  marriage  was  happy,  but  then  had 


Clinical  Cases  of  Hypnoidal  Treatment  383 

a  miscarriage  which  brought  her  down  in  health.  Her 
nervous  condition  became  aggravated  by  the  suicide 
of  her  brother.  Patient  occasionally  experiences  il- 
lusions and  hallucinations  of  memory  and  of  recognition, 
a  condition  which  she  thinks  she  has  inherited  from  her 
mother  who  has  gone  through  similar  experiences. 

When  I  first  saw  the  patient  she  was  in  great  emo- 
tional excitement.  She  cannot  eat,  cannot  sleep  and  is 
in  agony.  Wants  to  commit  suicide.  The  mother-in- 
law  tortures  her,  alienates  her  husband's  love,  intends 
to  separate  him  from  her.  The  evil  eye  of  the  mother- 
in-law  "hypnotizes"  her;  patient  "becomes  transfixed 
and  paralyzed  by  that  gaze. "  Her  will  power  is  gone, 
her  personality  is  fast  disappearing  under  the  baneful 
eye  of  the  mother-in-law.  Nothing  but  death  is  left  to 
her. 

The  patient  was  quieted  and  then  put  into  hypnoidal 
state  with  its  characteristic  relaxation.  After  the  first 
treatment,  patient  felt  somewhat  relieved  of  that  in- 
tense strain  in  which  she  was.  After  a  few  treatments 
by  hypnoidization,  she  felt  much  better,  "felt  perfectly 
normal,"  "was  herself  again,"  was  ready  to  meet  the 
exigencies  of  life  no  matter  how  unpleasant  they  might 
prove  to  be.  At  the  close  of  the  treatment,  patient  re- 
gards her  insistent  desire  to  talk  of  herself  as  foolish 
and  ridiculous;  she  realizes  that  she  has  magnified  trifles, 
that  she  has  misconstrued  the  relations  of  her  husband 
to  herself,  that  he  really  loves  and  is  devoted  to  her  as 
much  as  ever.  Her  emotional  tone  now  is  one  of  peace 
and  repose;  she  has  a  good  appetite,  sleeps  well,  has 
no  dreams,  and  has  gained  six  pounds. 

X.  Mrs.  S.  D.  Age  thirty-two.  American.  Mar- 
ried. Family  history  shows  neurosis.  Masturbated 
early  and  for  a  number  of  years.  She  is  very  religious, 
is  depressed  on  account  of  her  sins.  Suffers  from  in- 
somnia, lassitude,  great  fatigue,  crying  spells,  gastralgia. 


384     Causation  and  Treatment,  Psychopathic  Disease^ 

loss  of  appetite,  vomiting,  heartburn.  She  is  suggest- 
ible, capricious,  irritable,  sensitive,  suspicious,  suffers 
from  morbid  introspection,  indecision  and  doubts. 
Likes  routine;  anything  new  frightens  her.  Always 
dissatisfied  with  life,  becomes  easily  depressed  and  com- 
plains of  all  kinds  of  pain. 

Treated  by  the  hypnoidal  state  the  patient  improved 
considerably.  No  cure,  however,  could  be  effected  as 
the  patient's  psychopathic  condition  was  unfortunately 
kept  up  by  the  complicated,  unfavorable  family  life. 

XI.  Miss  D.  M.  Age  forty-three.  Family  history 
good.  Patient  was  well  until  a  year  ago,  when  menstru- 
ation became  irregular  and  menopause  set  in.  Patient 
suffers  from  backache,  occasionally  from  intense  pain 
around  the  sacral  and  coccygeal  region  and  the  back  of 
pelvis.  The  pain  shoots  up  the  back  of  right  and  left 
sides;  patient  faints  from  dizziness.  Some  physician 
told  her  it  was  duef  to  hemorrhage  into  the  kidneys. 
She  is  nervous,  restless,  has  lost  her  appetite,  suffers 
from  indigestion  and  from  insomnia.  A  few  months 
ago  she  happened  to  fall  down  from  a  car  and  since  then 
she  is  afraid  to  board  a  car  or  to  walk  upstairs. 

The  patient  was  but  a  short  time  under  treatment 
so  that  there  was  no  time  to  follow  the  case  closely,  but 
she  improved  rapidly  under  the  treatment  by  hypnoidi- 
zation. 

XII.  Mrs.  C.  K.  Age  forty-five.  Family  history 
good.  Children  are  all  well.  A  year  ago,  at  the  on- 
come  of  climacteric  period,  patient  became  nervous, 
sleepless,  lost  her  appetite,  had  flushes  and  flashes  of 
light,  suffered  from  headaches  and  worried  a  good  deal. 
She  is  very  religious,  and  is  mortified  by  her  unholy 
thoughts,  she  curses  and  blasphemes  the  Creator  in  her 
mind,  and  all  kinds  of  filthy  ideas  trouble  her,  especially 
when  she  prays.  She  is  in  agony  of  fear;  feels  she  is  a 
lost  soul.     "God  will  not  pardon  such  obscene,  out- 


Clinical  Cases  of  Hypnoidal  Treatment         385 

rageous  blasphemies  on  His  holy  name."  Patient  is 
despondent,  feels  greatly  depressed  and  is  unable  to  do 
anything,  cannot  do  her  housework  and  has  lost  interest 
in  her  family.  She  is  indifferent  to  her  friends  and  re- 
fuses all  social  intercourse.  She  keeps  on  brooding  and 
is  full  of  despair. 

It  took  me  some  time  to  gain  her  confidence.  It  was 
at  first  difficult  to  keep  her  quiet  and  have  her  relaxed. 
After  a  few  treatments  by  hypnoidization,  improve- 
ment set  in  rapidly  and  she  is  now  in  excellent  condition. 

XIII.  Miss  A.  W.  Age  thirty-five.  Irish;  house- 
keeper. Patient  is  well  nourished.  Physical  condition 
is  good;  menstruation  is  normal  and  painless.  Occa- 
sionally she  suffers  from  headache,  but  on  the  whole 
headaches  do  not  trouble  her.  She  suffers  much  from 
auditory  hallucinations  and  thinks  she  is  possessed  by 
demons.  From  her  ninth  years  she  suffers  from  hearing 
"  spirit- voices "  which  sometimes  tell  her  unpleasant 
things.  Along  with  the  hallucinations  she  also  has 
attacks  of  automatic  speech.  Occasionally  the  auto- 
matic speech  becomes  uncontrollable.  It  appears  to 
the  patient,  as  if  some  other  being  forces  her  to  tell 
what  she  thinks.  It  is  on  that  account  that  she  shuns 
society.  Her  family  in  Ireland,  being  aware  of  her 
trouble,  thought  it  was  demoniacal  possession.  Occa- 
sionally she  has  visual  hallucinations  of  angels  and 
saints. 

It  would  take  too  much  space  to  give  a  full  account 
of  this  interesting  case;  we  can  only  refer  to  it  in  its 
main  outlines,  as  our  object  here  is  not  so  much  the 
psychopathological  as  the  psychotherapeutic  aspect  of 
the  cases. 

The  patient  could  not  be  hypnotized,  but  she  went 
easily  into  the  hypnoidal  state.  At  first  the  improve- 
ment was  rather  slight.  In  fact,  now  and  then  the 
hallucinations  and  the  automatic  speech  became  even 


386     Causation  and   Treatment^  Psychopathic  Diseases 

more  frequent  and  more  annoying  than  before.  After 
a  couple  of  months  of  treatment,  the  outlook  began  to 
be  somewhat  brighter,  the  auditory  and  visual  halluci- 
nations began  to  give  way,  the  automatic  speech  con- 
siderably diminished  and  became  more  controllable. 
After  a  few  months'  treatment  by  hypnoidization,  all 
the  symptoms  completely  disappeared. 

XIV.  Mrs.  M.  R.  Age  thirty-eight.  American. 
Married.  Family  history  good,  children  well.  Patient 
is  pale,  looks  worried,  nervous,  has  little  appetite  and 
suffers  from  insomnia.  Suffers  from  headaches,  pneu- 
matosis, pyrosis,  eructations,  has  attacks  of  vomiting. 
Menstruation  is  scanty,  irregular,  and  painful.  When 
about  the  age  of  nine,  she  met  with  an  accident, — she 
fell  out  of  a  carriage  and  was  unconscious;  about  the 
age  of  twelve,  she  had  an  accident  with  a  runaway 
horse.  Since  that  time  she  has  the  greatest  terror  to 
ride  in  a  carriage,  but  enjoys  much  automobiling.  She 
also  has  an  uncontrollable  fear  of  dogs.  When  a  child, 
she  was  attacked  by  a  dog  and  then  heard  and  read  a 
good  deal  about  hydrophobia.  In  fact,  after  she  was 
bitten  by  the  dog,  the  sensations  she  experienced  in  the 
throat  seemed  to  her  to  be  hydrophobia.  The  fear  of 
dogs  occasionally  sets  in  as  an  attack  and  comes  to  the 
surface  of  her  consciousness  during  states  of  extreme 
fatigue.  She  especially  suffered  from  it  during  preg- 
nancy. Many  of  the  details  of  the  accidents  were  re- 
vealed in  the  hypnoidal  state,  although  she  had  a  gen- 
eral knowledge  of  them  during  her  ordinary  condition 
and  was  painfully  conscious  of  them  during  many  of  the 
attacks.  A  number  of  details  became  subconscious 
and    were    disclosed    during   the    hypnoidal    state. 

A  series  of  treatments  by  hypnoidization  greatly  re- 
lieved the  distressing  symptoms,  but  the  treatment 
was  not  continued  long  enough  to  obtain  permanent 
results. 


Clinical  Cases  of  Hypnoidal  Treatment         3  87 

XV.  Mr.  C.  B.  Age  thirty-nine.  Single.  Rus- 
sian. Builder.  Father  died  of  apoplexy  at  the  age  of 
seventy-two.  Mother  is  seventy-seven  years  old,  but 
has  always  been  nervous.  Brothers  and  sisters  are  all 
well.  Patient  is  rather  undersized,  about  five  feet,  two 
and  one-half  inches,  and  weighs  about  ninety-seven 
pounds.  He  looks  emaciated,  anemic,  cachectic.  Has 
no  appetite;  suffers  from  indigestion,  nausea,  gastralgia. 
Anything  unpleasant  makes  him  feel  nauseated. 
Detailed  inquiry  of  early  sexual  life  discloses  no  abnor- 
malities. All  those  symptoms  set  on  about  twelve 
years  ago  when  patient  had  an  attack  of  gonorrhea 
of  which  he  was  greatly  frightened  and  kept  on  worry- 
ing about  its  consequences.  He  suffered  then  a  good 
deal  from  nausea,  which  afterwards  persisted.  The 
feeling  of  nausea  became  exacerbated  with  his  father's 
death.  Patient  is  extremely  introspective  and  suggest- 
ible in  regard  to  sickness.  If  any  of  his  family  hap- 
pen to  have  some  trouble,  he  is  sure  to  be  sick  with  the 
same  symptoms.  Thus,  about  two  months  ago,  the 
patient's  mother  fell  and  broke  her  left  arm.  Patient 
began  to  feel  pain  in  the  left  arm  and  had  to  be 
treated  for  it.  He  tells  me  that  every  new  moon  he 
experience  irritation  in  rectum  and  around  the  anus. 
This  e  kept  up  from  his  boyhood  and  is  due  to  the 
fact  that  about  the  time  of  the  new  moon  his  mother, 
in  her  old-fashioned  super  titious  way,  used  to  admin- 
ister to  him  a  purgative. 

Put  in  the  hypnoidal  state,  patient  felt  much  relieved. 
The  1  cneficial  results  of  the  hypnoidal  treatment  be- 
came manifest  at  the  end  of  a  few  weeks. 

XVI.  Mr.  J.  R.  Age  twenty-eight.  American. 
College  education.  Family  neurotic.  Patient  is  great- 
ly emaciated.  Appetite  is  poor.  Bowels  are  costive. 
Sleep  is  disturbed  by  dreams  and  is  usually  restless. 
He     is     emotional,     impulsive    and    has     periods     of 


388     Causation  and  Treatment,  Psychopathic  Diseases 

feeling  of  well-being  alternating  with  periods  of  depres- 
sion. In  the  periods  of  depression  he  is  apt  to  become 
taciturn,  gloomy,  retiring  and  brooding  over  his  health 
and  mental  troubles.  For  a  couple  of  years  in  succes- 
sion he  somewhat  lost  in  flesh,  caught  colds  and  coughed. 
The  fear  of  consumption  seized  on  him  and  he  went  to 
Arizona  for  his  health.  He  was  possessed  by  the  fear 
of  tuberculosis,  although  the  best  specialists  assured 
him  that  his  trouble  was  largely  of  nervous  origin.  In 
Arizona,  the  patient  lived  a  regular,  normal  life  in  the 
open  air,  regained  his  physical  health,  and  got  rid  of  his 
fear  of  tuberculosis  and  colds.  This,  however,  did  not 
last  long.  A  couple  of  years  later,  when  he  happened 
to  catch  a  cold,  the  fear  of  tuberculosis  reappeared. 
Any  irritation  in  the  trachea,  any  little  cough  due  to 
some  dust,  any  little  congestion  in  the  pharynx,  meant 
a  cold  with  its  underlying  fear  of  "consumption." 
This  fear  was  further  em.phasized  by  a  near  relative 
who  happened  to  suifer  from  colds.  The  patient  was 
also  obsessed  by  other  insistent  ideas.  When  he  saw 
numbers,  such  as  the  date  of  the  year,  for  instance,  he 
added  them,  and  liked  that  certain  numbers,  such 
as  twenty-five  or  thirty-five,  should  come  out.  If  the 
results  did  not  come  out,  he  kept  inserting  figures  or 
subtracting  until  the  desirable  result  was  obtained. 
When  he  saw  words,  he  looked  at  the  letters  and  wanted 
that  a  certain  number  of  "i's"  and  "r's"  should  be 
there.  If  the  number  of  letters  did  not  suit  him,  he 
inserted  "i's"  and  "r's"  to  suit  himself.  The  insistent 
ideas  of  this  kind,  however,  were  not  accompanied  by 
any  emotional  disturbances. 

The  treatment  of  the  case  covered  a  period  of  about 
two  years.  The  condition  was  obstinate,  diflicult  to 
control.  The  symptoms  kept  on  recurring  with  great 
insistency.  Persistent  treatment,  however,  during  the 
hypnoidal    state,    finally    reduced    the    fears    and    the 


Clinical  Cases  of  Hypnoidal  Treatment         389 

insistent  ideas.  The  patient  lost  his  fear  of  consump- 
tion, did  not  catch  so  many  colds;  he  cared  little, if  he 
did  catch  any.  His  brooding  disposition  left  him,  and 
he  devoted  himself  to  his  work. 

XVII.  Mrs.  J.  F.  Age  twenty-eight.  American. 
Married.  Family  history  good.  For  many  years  has 
been  suffering  from  headache,  backache,  general  fatigue, 
weakness  in  the  eyes,  which  occasionally  becomes  very 
painful.  The  headaches  were  sometimes  intense,  so 
that  the  patient  was  in  agonies,  the  pains  extended  all 
over  the  head,  shooting  down  the  back.  There  were 
present  sore  spots  in  the  back  of  the  head,  the  pressure 
on  which  made  the  patient  feel  more  relieved.  Dur- 
ing menstruation  the  headaches  became  more  severe 
than  usual.  She  also  complained  of  various  pains  in 
the  right  iliac  region.  Patient's  appetite  was  irregular, 
nothing  tasted  well  to  her,  nutrition  was  poor,  con- 
stipation present.  She  suffered  occasionally  from 
bulimia.  The  muscular  condition  was  rather  flabby. 
Heart  in  good  condition,  though  somewhat  irregular, 
due  to  the  patient's  nervousness.  No  albumen  in  the 
urine.  A  gynecologist  diagnosed  salpingitis  and  ad- 
vised an  operation  on  account  of  adhesions  formed. 
The  patient,  however,  refused  to  be  operated.  Patient 
gets  a  headache  as  soon  as  she  reads  a  few  pages  in  a 
book.  This  suggested  the  oculist,  who  measured  her 
with  a  pair  of  glasses,  but  the  eyes  were  as  weak  as 
before,  the  headaches  were  as  easily  induced  and  as 
persistent  and  severe  as  ever. 

When  under  my  care,  after  trying  the  gynecologist 
with  his  tampons  and  pessaries,  and  then  again  the 
oculist  with  his  glasses,  I  was  forced  regretfully  to 
abandon  the  advice  of  both  professions  and  turn  to 
my  hypnoidization.  The  patient  was  glad  to  find  that 
she  did  not  need  all  those  complicated  professional 
outfits,  and  after  a  year's  treatment  felt,  as  she  put  it, 


390     Causation  and  Treatment,  Psychopathic  Diseases 

"younger  than  ever. "  The  dysmenorrhea  disappeared, 
the  headache  was  gone,  the  eyes  without  spectacles 
felt  far  stronger  and  did  not  ache;  she  gained  in  flesh, 
and  in  strength,  and  is  now  in  good  health. 
A  child  born  to  patient  a  couple  of  years  later  helped 
the  cure,  regulating  and  moderating  the  impulse  of  self 
and  instinct  of  fear. 

XVIII.  Miss  G.  A.  American.  Age  fifty-five. 
Father  died  of  pneumonia.  Mother  died  of  fatty  de- 
generation of  the  heart.  Three  brothers  died  of  vari- 
ous forms  of  cardiac  lesions.  One  of  the  sisters  had 
acromegaly  and  died  of  heart  trouble.  In  the  collateral 
branches  of  the  family  there  are  histories  of  tuber- 
culosis. Patient  looks  poorly  nourished;  her  appetite 
is  completely  gone.  Menstruation  stopped  some  ten 
years  ago.  Patient  suffers  from  insomnia,  headaches, 
backache,  general  diffused  pains  all  over  the  body, 
complains  of  lassitude  and  loss  of  interest  in  what 
goes  on  about  her.  She  feels  despondent  and  has 
acute  crying  spells.  She  is  afraid  of  losing  her  mind. 
When  a  child,  used  to  suffer  from  night  terrors.  When 
about  the  age  of  twelve,  she  took  a  long,  fatiguing  jour- 
ney with  her  parents.  She  was  so  exhausted  that  on 
her  return  she  was  aphasic  and  paraplegic,  and  was 
confined  to  bed  for  six  months.  The  present  condition 
set  on  a  few  years  ago;  she  has  lost  the  sense  of  smell 
and  of  taste,  and  is  much  depressed. 

I  must  confess  that  when  I  undertook  the  case  I 
did  not  expect  any  favorable  results.  It  was  an  old, 
chronic,  insidious  case.  The  age  of  the  patient  as  well 
as  the  family  history  were  by  no  means  encouraging. 
The  first  couple  of  months  the  treatment  dragged  along 
indiiferently,  all  I  could  then  say  was  that  the  patient 
did  not  get  worse  under  the  treatment.  The  hypnoidal 
state,  however,  gradually  admitted  me  into  the  patient's 
early  history  and   I  obtained  important  clues  to  her 


Clinical  Cases  of  Hypnoidal  Treatment  391 

symptoms.  Here  comes  in  the  value  of  the  knowledge 
of  the  course  and  development  of  the  malady  and  the 
consequent  help  in  the  treatment  of  the  dissociated 
systems.  With  a  better  insight  into  the  abnormal 
psychology  of  the  case  the  hypnoidal  state  could  be 
used  to  better  advantage.  The  patient  began  to  im- 
prove rapidly  and  at  the  end  of  the  fourth  month  of 
treatment  by  hypnoidization  completely  recovered. 
It  is  now  more  than  twelve  years  since  the  end  of  the 
treatment,  and  I  may  say  that  the  patient  has  not  had 
a  single  relapse,  she  continues  to  stay  well,  she  has 
become  an  energetic  social  worker,  greatly  valued  for 
her  indomitable  energy  as  well  as  cheerfulness  of  mind. 
People  who  know  her  say  that  "wherever  she  goes  she 
brings  sunshine  with  her."  A  new  life  was  awakened 
in  her.  The  subconscious  reserve  energy  which  has 
remained  dormant  in  her  for  so  many  years  has  become 
unlocked  and  utilized  in  her  ordinary  daily  life. 

In  the  control  of  alcoholism  the  treatment  by  hyp- 
noidization has  yielded  extremely  satisfying  results.  The 
principle  of  subconscious  reserve  neuron-energy  stands 
out  clear  and  distinct  in  such  cases.  A  few  cases  will, 
perhaps,  best  illustrate  my  meaning. 

XIX.  Mr.  G.  S.  American.  Single.  Age  thirty- 
seven.  Family  history  is  good,  except  that  one  ma- 
ternal uncle  was  a  victim  of  the  drink  habit.  Patient 
is  physically  well  developed.  A  physical  examination 
showed  an  irregular  heart  due  to  drink  and  excessive 
smoking.  Liver  enlarged  and  cirrhotic.  The  patient 
was  brought  just  after  a  debauch,  was  weak,  nervous 
and  shaky,  with  quite  an  extensive  tremor  of  the  hands. 
He  began  to  drink  when  in  school  as  a  matter  of  boon 
companionship,  and  since  then  became  addicted  to  the 
drink  habit.  He  kept  on  drinking  regularly,  and  at 
times  actually  soaking  in  alcoholic  beverages.     He  has 


392     Causation  and  Treatment,  Psychopathic  Diseases 

gone  through  a  series  of  treatments  in  various  establish- 
ments for  the  cure  of  alcohoUcs,  but  with  no  appreci- 
able results.  As  soon  as  he  got  out  of  the  sanitarium, 
he  immediately  went  off  on  a  debauch.  A  number  of 
times  he  suffered  from  severe  attacks  of  delirium 
tremens.  The  family  despaired  of  his  condition,  and  he 
himself  proposed  to  give  up  business  and  devote  him- 
self to  his  obsession. 

Under  a  rigorous  treatment  by  the  hypnoidal  state, 
the  patient  began  to  improve  steadily.  His  physical 
and  mental  conditions  grew  in  strength.  After  a  few 
months'  treatment  he  went  back  to  his  business.  The 
man  has  become  completely  reformed  in  his  habits  of 
life.  He  is  now  manifesting  an  extraordinary  activity, 
devotion  to  and  steadiness  in  his  work.  No  one  sus- 
pected in  him  before  such  capacities  of  business  manage- 
ment, such  foresight  and  energy  in  carrying  on  his 
business.  New  stores  of  subconscious  reserve  energy 
have  welled  up  from  the  depths  of  his  being.  He  has 
become  another  man  at  whom  his  own  brothers  are 
surprised  on  account  of  the  extraordinary  change 
produced. 

XX.  J.  L.  Irish.  Protestant.  Age  fifty-seven. 
Family  history  good,  except  for  the  fact  that  his 
brother  is  also  addicted  to  drink  and  has  been  under 
my  care  for  a  few  weeks,  with  the  result  of  leaving  oflF 
drink  for  two  years  and,  after  having  had  two  relapses, 
has  completely  recovered.  Patient  is  a  printer  by 
trade  and  has  been  drinking  for  over  thirty  years. 
While  he  is  usually  kind  natured,  when  under  the  in- 
fluence of  drinks  he  is  violent,  abusive,  offensive,  and 
even  brutal  to  his  wife  and  eight  children  who  are 
afraid  of  him.  From  his  sister  and  from  his  wife  I 
have  the  information  that  periodically  patient  goes  off 
on  a  long  spree  and  spends  all  his  money,  neglecting 
his  wife   and   children,    and    when  he  comes  home  he 


Clinical  Cases  of  Hypnoidal  Treatment  393 

brutally  abuses  everybody  in  the  house.  "It  is  not 
a  home,  it  is  a  hell,"  as  his  sister  puts  it.  In  his 
better  moments  the  patient  himself  admits  he  is  a  brute, 
that  drink  has  the  best  of  him.  He  must  keep  away 
from  drink  completely,  because  the  mere  taste  of  it 
sets  him  going.  An  examination  reveals  the  presence 
of  arteriosclerosis. 

I  found  the  hypnoidal  state  would  meet  with  no 
resistance.  Hypnoidization  then  was  the  order  of  the 
day.  The  patient  began  to  improve,  was  less  nervous, 
slept  better,  and,  what  was  more  important,  stopped 
drinking  and  did  not  crave  for  liquor.  After  three 
weeks  of  treatment,  by  means  of  hypnoidization,  the 
patient  was  discharged.  He  did  not  drink  for  a  whole 
year,  but,  coming  in  contact  with  other  workmen  in 
the  union,  he  was  invited  to  drink,  could  not  refuse, 
and  once  more  was  started  on  his  old  career.  He 
came  back  to  me  and  this  time  I  worked  at  him  for 
a  month  with  more  perseverance.  Throughout  the 
treatment,  the  hypnoidal  state  was  used.  The  patient 
has  given  up  his  drink  habit,  has  no  craving  for  liquor, 
works  regularly  at  his  job  and  no  longer  associates 
with  companions  who  are  given  to  drink.  His  sis- 
ter and  his  wife  keep  me  regularly  informed  of  his 
condition  and  the  report  for  the  last  two  years  has 
been:  "John  is  very  good,  he  is  a  gentleman,  treats 
the  children  well."  He  has  become  a  model  father 
and  a  good  husband. 

XXI.  C.  T.  Age  thirty-two.  American.  Single. 
Family  history  bad,  father  drank,  was  off  on  sprees, 
and  was  drowned  while  in  a  state  of  intoxication.  A 
maternal  as  well  as  paternal  uncle  were  confirmed 
drunkards,  and  there  was  drunkenness  in  the  collateral 
branches  of  the  family.  The  patient  learned  to  drink 
when  very  young.  His  mother,  who  volunteered  the 
information,    told    me    that    she    suspected    that   the 


394     Causation  and  Treatment,   Psychopathic  Diseases 

patient  learned  to  drink  at  the  age  of  seven.  Since 
that  time  the  drink  habit  grew  on  him,  and  finally 
he  took  to  liquor  and  became  a  habitual  drunkard  at 
the  age  of  twenty.  The  physical  condition  of  the 
patient  is  good.  The  patient  is  of  a  mild  disposition, 
but  it  seems  as  if  the  alcohol  has  soaked  all  the  good 
out  of  him.  He  has  no  ambition,  and  is  not  fit  to  do 
anything,  he  is  constantly  under  the  influence  of 
drink.  He  has  no  will,  no  responsibility  and  nothing 
of  any  importance  can  be  intrusted  to  him.  Socially, 
he  is  ostracized  by  his  relatives,  but  he  seems  to  mind 
it  little. 

The  family  and  the  personal  history,  as  well  as  the 
condition  of  the  patient,  greatly  discouraged  me.  I  felt 
there  was  no  chance  for  him,  no  use  of  trying  even.  The 
family  insisted  on  treatment,  even  if  there  was  only  one 
chance  in  a  thousand  that  the  patient  could  be  saved. 
The  mother  was  anxious  to  put  him  under  my  treatment, 
he  was  her  only  son.  The  treatment  of  the  patient  last- 
ed for  about  a  year,  and  was  carried  out  by  means  of  the 
hypnoidal  state.  To  my  great  surprise,  and  contrary 
to  my  expectation,  the  patient  has  completely  given 
up  his  drink.  In  fact,  he  changed  so  much  that 
his  own  mother  wondered  at  the  transformation.  He 
became  ambitious,  manifested  a  self-control  which 
none  who  knew  him  had  ever  suspected  in  him.  He 
became  methodical,  systematic,  and  conscientious  in 
his  work,  and  showed  an  unusual  ability  in  management. 
From  being  weak  and  unreliable  in  character,  he  became 
firm  and  trustworthy.  His  abilities  were  soon  noticed 
and  appreciated,  and  he  has  since  become  a  manager 
of  a  large  concern.  I  may  add  that  the  only  traits 
that  remained  to  him  from  his  former  life  were  his 
kindheartedness  and  effusiveness.  Nowhere  have  I 
seen  such  Hmitations,  moral  weakness,  and  lack 
of    capacity     changed       to      strength    of     will    and 


Clinical  Cases  of  Hypnoidal  Treatment  395 

purpose  combined  with  ability  to  guard  and  guide 
complicated  interests  of  a  large  business.  After  a  case 
like  that  with  so  little  hope  I  am  more  guarded  as  to  the 
possible  outcome  in  treatment  of  apparently  the  most 
hopeless  alcoholic  case.  There  is  more  efficacy  in  the 
treatment  by  the  hypnoidal  state  than  I  have  dared 
to  think  of. 


CHAPTER   XX 


THE    HYPNOIDAL    STATE    AND    RESERVE    ENERGY 

WE  have  pointed  out  that  a  dissociated, 
subconscious  system  reacts  reflexly  with 
an  energy  uncontrolled  and  unre- 
strained by  other  systems.  Associ- 
ated systems,  on  the  other  hand,  control,  regulate  and 
inhibit  one  another,  with  a  consequent  saving  of  neuion- 
energy.  We  have  further  pointed  out  that  in  a  group  of 
associated  systems  each  component  system  becomes  less 
accessible  to  external  stimulation,  as  far  as  reaction  is 
concerned, — it  responds  less  readily  with  a  discharge  of 
energy.  The  external  stimulus  must  rise  above  the 
ordinary  stimulus  to  set  the  system  into  activity.  In 
proportion  as  the  complexity  of  the  group  of  systems 
grows,  the  threshold  to  which  the  group  reacts  keeps 
on  rising,  and  may,  in  fact,  even  amount  to  a  total 
inhibition. 

This  principle  of  rise  of  threshold  and  of  total  in- 
hibition due  to  group-complexity  is  well  illustrated  by 
the  remarkable  experiments  carried  on  in  Professor 
Pavlow's  laboratory. 

When  a  stimulus  is  associated  with  that  of  the  con- 
ditional reflex,  the  result  is  not  an  increase,  not  an 
indifference  to,  but  a  total  inhibition  of,  the  conditional 
reflex.  Vasiliev,  working  in  Pavlow's  laboratory, 
associated  the  sound  of  a  metronome  with  the  con- 
ditional reflex  of  a  scratch  stimulus.  He  finds  that  the 
process  of  inhibition  runs  in  three  phases  for  intense 
associated  stimuli  and  in  two  phases  for  weak  ones. 

396 


The  Hypnoidal  State  and  Reserve  Energy         397 


I  Phase. 
1 .  6cc. 


II  Phase. 
l.o 

0.4 


III  Phase. 
2.0 


0.3 
0.6 


2.6 
1.2 


Scratch  stimulus 

Scratch  stimulus    and    sound    of 
metronome 

Scratch  stimulus 
Scratch  stimulus 

Scratch  stimulus  and  sound  of  metro- 
nome o 

Savadsky  has  modified  the  conclusions  of  the  pre- 
vious investigators,  but  he  affirms  the  fact  that  an 
intense  stimulus,  an  intense  sound,  completely  anni- 
hilates the  secretion  due  to  scratch-stimulation,  while 
a  weak  stimulus,  a  weak  sound,  produces  a  lesser 
effect.  He  finds  that  the  external  stimulus  disturbs 
or  inhibits  the  condition  of  the  nerve  centers,  inhibits 
the  condition  which  is  predominant  at  that  moment, 
stimulating  the  inhibitory  stage  and  inhibiting  the 
excitatory  stage;  in  other  words,  inhibiting  whatever 
process  is  at  that  moment  taking  place. 

The  following  table,  showing  the  inhibitory  influence 
of  intense  stimulations  associated  with  the  conditional 
reflex,  may  serve  as  an  illustration.  The  conditional 
reflex  is  formed  from  a  scratch-stimulus,  intense  whistle, 
or  intense  sound  of  bell  as  simultaneous  extraneous 
stimulation. 


Magnitude  of 
THE  Conditional 
Reflex  in  Drops. 

Parotid  Gland. 

6 

i 

6     S 

S 

0 
0 
0 

1 

0 

0 

4      6     7 
7     12    12 

Intense  sound  of  whistle — 

0 

0 

0 

1  1    2      2 

7  1  14    17 

— ^The  effect  of  simultaneous 

stimulation 

Intense  sound  of  bell — 

1 
0 

0 
0 

0    0 
0    0 

0    0 
0    0 

8 
0 

0 
3 

10 
0 

2 
5 

12 
0 

8 
10 

— ^The  effect  of  simultaneous 

stimulation 

398     Causation  and  Treatment,  Psychopathic  Diseases 

In  summarizing  the  work  of  previous  investigators 
in  Pavlow's  laboratory,  Orbeli  says:  "Vasiliev  and 
Mishtovt  have  shown  that  any  phenomenon  indifferent 
in  itself  may  not  only  become  a  source  of  a  new  con- 
ditional reflex,  but  may  become  a  special  inhibitory 
agent  in  relation  to  the  existing  conditional  reflexes,  it 
is  only  requisite  that  the  phenomenon  should  be  repeat- 
edly associated  with  the  conditional  reflex  in  such 
cases  when  the  latter  is  not  reinforced,  that  is,  when 
not  accompanied  by  the  unconditional  reflex.  If 
for  instance,  phenomenon  A  coincides  in  time  with 
the  unconditional  reflex  of  the  salivary  gland,  the 
phenomenon  A  becomes  a  source  of  conditional  salivo- 
secretory  reflex.  If,  however,  in  cases  when  A  comes 
separately  without  the  unconditional  reflex,  a  new 
phenomenon  B  is  associated  with  A,  B  gradually 
becomes  a  source  of  inhibition  of  the  conditional  reflex. 
The  relation  formed  is  such  that  A  phenomenon  by 
Itself  calls  out  a  secretion  of  saliva,  while  in  association 
with  B  does  not  call  out  any  saliva;  that  is,  B  inhibits 
the  action  of  A.  That  phenomenon  is  termed  in 
Pavlow's  laboratory  "conditional  Inhibition."  B  is 
the  conditional  Inhibition  in  relation  to  the  conditional 
reflex  on  A.  This  quality  of  the  nervous  system  to 
work  out  special  cases  of  inhibition  makes  the  condi- 
tional reflexes  an  extremely  delicate  and  perfect  index 
of  reactions  of  the  organism  to  its  external  environment. 
The  animal  reacts  only  to  those  phenomena  which 
really  coincide  with  that  or  other  specific  stimulation 
and  serve  as  signals  of  the  latter.  When,  however, 
an  extraneous  stimulus  becomes  associated,  a  stimulus 
which  serves  as  a  signal  of  unreality  of  the  nervous 
phenomenon,  the  reaction  becomes  arrested  and  the 
organism  thus  rids  Itself  of  fruitless  labor." 

On  the  strength  of  his  own  experiments  performed 
on  the  visual  reflexes  of  the  dog,  Orbeli  comes  to  the 


The  Hypnoidal  State  and  Reserve  Energy        399 

same  conclusion  with  Vasiliev  and  Mishtovt,  Babkin 
and  Savadski,  "that  every  phenomenon  which  coincides 
with  the  conditional  reflexes  in  all  cases  when  the  latter 
is  not  accompanied  with  the  unconditional  reflex 
becomes  an  inhibition  in  relation  to  that  same  con- 
ditional reflex." 

Similarly,  in  the  experiments  now  carried  on  in  my 
laboratory,  I  find  that  when  a  galvanic  deflection  is 
brought  about  by  a  specific  stimulation  of  painful 
character,  the  co-existence  of  another  stimulation  is 
apt  to  decrease  the  magnitude  of  the  galvanic  reflex. 

The  more  numerous  the  components  of  a  system 
become,  the  more  the  given  group  of  systems  grows  in 
complexity,  the  longer  becomes  its  latent  period  of 
stimulation,  the  higher  rises  its  threshold,  the  greater, 
we  may  say,  is  the  inhibition  of  its  activity.  We  may 
say  that  the  inertia  of  a  group  increases  with  its  mass. 
To  set  into  activity  a  complex  system,  a  greater  stimulus 
is  requisite  than  the  one  necessary  to  set  into  function 
any  of  the  individual  components.  The  minimum 
threshold  of  the  system  must  at  least  be  the  maximum 
threshold  of  one  of  its  constituents.  As  Sherrington 
puts  it:  "Yet  it  is  also  clear  that  the  threshold  for  any 
whole  arc  cannot  be  lower  than  the  highest  individual 
threshold  in  it.  Similarly,  an  additive  influence  of  the 
threshold  will  make  the  reflex  chain,  consisting  of  several 
neurons,  offer  caeteris  paribus  higher  resistance  than  a 
chain  of  fewer  neurons.  It  is  in  accord  with  the  rule 
that  the  reflex  chain  which  conducts  to  parts  seg- 
mentally  distant  requires  generally  intenser  stimulation 
to  excite  them  than  do  merely  local  arcs." 

All  other  conditions  remaining  the  same,  the  arousal 
of  a  complex  system  requires  also  an  increase  of  time. 
The  higher  and  more  complex  the  nervous  and  mental 
processes  are,  the  greater  are  their  reaction  times. 
With  the  complexity  of  the  group  of  associated  systems 


400     Causation  and   Treatment,  Psychopathic  Diseases 

belonging  physiologically  to  different  and  distant  parts 
of  the  cerebral  system,  the  initial  stimulation  or 
stimulus-threshold  becomes  greater  and  the  time  of 
stimulation  or  latent  period  becomes  longer.  In  other 
words,  the  threshold  of  the  group  rises  with  the  increase 
of  associative  components  belonging  to  different  spheres 
of  sensory  regions  with  their  concomitant  presentative 
and  representative  elements,  forming  the  synthesis  of 
the  organized  group. 

A  great  number  of  associations  are  formed  in  the 
course  of  life-adjustments,  with  the  result  that  the 
thresholds  of  some  or  even  of  many  systems  may  become 
inaccessible  to  the  ordinary  stimuli  of  the  customary 
environment.  The  life  reactions  of  the  individual 
may  thus  become  limited  and  narrowed  down  to  a 
contracted  sphere  of  activity  in  response  to  a  limited 
number  of  stimulations.  Consciousness  and  life  in- 
terests become  narrowed,  contracted,  giving  rise  to 
various  forms  of  psychopathic  dissociations  and 
affections  with  their  anaesthesias,  motor  paralyses  and 
abulias,  with  their  inhibitions  of  functions  of  various 
systems  in  the  domain  of  sensation,  emotion,  intellect, 
and  will. 

This  rise  of  threshold,  and  the  concomitant,  systemic, 
mental  paralysis  with  its  consequent  limitation  of 
response  and  reaction  to  the  external  environment, 
should,  however,  be  regarded  as  forming  but  one  side 
of  the  psychopathic  affections.  The  inaccessible  regions 
lie  fallow  and  await  the  favorable  moment  for  the 
manifestation  of  their  riches  and  fertility.  The  inactive 
systems,  being  in  their  resting,  anabolic  stage,  become 
surcharged  with  latent  energy  awaiting  the  appropriate 
stimulus  effectual  in  the  liberation  of  the  dormant 
energy.  This  subconscious,  dormant,  reserve  energy 
is  of  the  utmost  consequence  to  the  individual  in  the 
critical  moments  of  his  struggle  for  life.     In  the  struggle 


The  Hypnoidal  State  and  Reserve  Energy        401 

for  life  such  a  surplus  of  energy  is  a  great  advantage 
to  the  organism.  Those  organisms  have  a  better 
chance  for  survival  that  have  laid  by  for  a  rainy  day; 
the  chance  of  survival  becomes  greater  as  the  stored~up 
energy  is  greater.  This  principle  of  reserve  energy 
was  set  forth  by  Professor  James  and  also  by  me  in 
my  various  works. 

The  late  Charles  S.  Minot,  the  great  American 
histologist,  points  out  from  another  standpoint,  this 
reserve  energy  present  in  the  organism,  a  reserve 
energy  of  growth  called  forth  under  special  emergen- 
cies of  life. 

"How  many  of  you  have  thought  what  the  lesson 
of  the  skin  is  in  regard  to  the  power  of  growth  ?  Spring 
is  coming;  we  shall  soon  be  taking  to  our  boats,  rowing 
or  canoeing,  and  the  first  day  we  do  so,  doubtless,  we 
shall  have  blisters  upon  our  hands,  and  the  outer  part 
of  the  skin,  raised  by  the  blister,  will  probably  fall  off 
and  be  lost  altogether.  The  softer,  underlying  skin 
will  be  exposed,  will  be  sensitive  and  uncomfortable 
for  a  while,  but  soon  the  cells  behind  the  surface  will 
assume  a  horny  character,  the  cells  underneath  will 
grow  and  multiply,  and  presently  the  wound  will  be 
healed  over.  Did  you  ever  stop  to  think  that  that 
means  there  is  a  reserve  -power  of  growth  in  the  skin  all 
the  time,  always  ready  to  act,  to  come  forward,  waiting 
only  for  the  chance,  and  that  there  is  besides  something 
which  keeps  it  in,  which  holds  it  back,  which  stops  it? 
We  call  this  stopping  physiological  function — inhibi- 
tion. " 

By  a  striking  series  of  instructive  facts,  Dr.  Meltzer 
points  out  that  "all  organs  of  the  body  are  built 
on  the  plan  of  superabundance  of  structure  and  energy." 
Like  Minot,  Meltzer  refers  to  the  significant  fact  that 
most  of  our  active  organs  possess  a  great  surplus  of 


402     Causation  and   Treatment,  Psychopathic  Diseases 

functioning    cells.     This    surplus    is    requisite    for    the 
safety  of  the  individual. 

The  principle  of  reserve  energy  is  ;  f  the  utmost  im~ 
portance  to  abnormal  psychology.  The  principle  is 
based  on  a  broad  generalization  of  facts,^ — psychological, 
physiological  and  biological, — namely,  that  far  less 
energy  is  utilized  by  the  individual  than  there  is  actually 
at  his  disposal.  A  comparatively  small  fraction  of  the 
total  amount  of  energy,  possessed  by  the  organism,  is 
used  in  its  relation  with  the  ordinary  stimuli  of  its 
environment. 

The  energy  in  use  may  be  regarded  as  the  kinetic 
or  circulating  energy,  while  the  energy  stored  away  is 
the  reserve  energy.  There  must  always  be  a  reserve 
supply  of  energy  requisite  for  unusual  reactions  in 
emergency  cases.  Those  organisms  survive  which 
have  the  greatest  amount  of  reserve  energy,  just  as 
those  countries  are  strong  and  victorious  in  the  world- 
market  which  possess  the  largest  amount  of  reserve 
capital  to  draw  upon  i     critical  periods. 

As  life  becomes  more  complex,  inhibitions  increase; 
the  thresholds  of  stimulations  of  a  complex  system 
rise  in  proportion  to  its  complexity.  With  the  rise 
of  evolution  there  is  a  tendency  to  increase  of  inhibi- 
tions, with  a  consequent  lock-up  of  energy  which  be- 
comes reserve.  Now  there  are  occasions  in  the  life 
of  the  individual,  under  the  influence  of  training  and 
emotional  trauma,  when  the  inhibitions  become  un- 
usually intense  and  tend  to  smother  the  personality, 
which  becomes  weakened,  impoverished  in  its  re- 
actions and  is  unable  to  respond  freely  to  the  stimuli 
of  its  environment.  The  inhibited  system  becomes 
inactive  and  may  be  regarded  as  dissociated  from  the 
cycle  of  life. 

In  case  of  an  emotional  trauma  there  is  often 
a     breach    in    the    continuity    of    association.     The 


The  Hypnoidal  State  and  Reserve  Energy        403 

affected  system  becomes  dissociated  from  the  rest 
of  the  personality  and  is  Hke  a  spHnter  in  the  flesh  of 
the  individuality.  Its  own  threshold,  when  tapped, 
may  be  very  low,  but  it  is  not  directly  accessible  through 
the  mediacy  of  other  systems;  hence  its  threshold 
appears  unusually  or  pathologically  high.  When  the 
inhibitions  are  very  high  they  must  be  removed.  This 
removal  of  inhibitions  brings  about  an  access  to  the 
accumulated  energy  of  the  inhibited  systems.  In 
case  of  disjunction  or  break  of  continuity  we  must 
stimulate  the  dormant  reserve,  energy  of  the  systems, 
and  thus  assist  the  process  of  repair  and  bridge  the 
breach  of  associative  continuity.  A  new,  fresh, 
active  life  opens  to  the  patient.  He  becomes  a  "re- 
formed" personality,  free  and  cheerful,  with  an  over- 
flow of  energy. 

The  hypnoidal  state  is  essentially  a  rest-state 
characterized  by  anabolic  activity.  There  is  a  restitu- 
tion of  spent  energy;  inhibitions  become  removed,  and 
access  is  gained  to  "dormant"  systems  or  complexes. 
The  awakened  "dormant"  complex  systems  bring 
with  them  a  new  feeling-tone,  a  fresh  emotional  energy 
resulting  in  an  almost  complete  transformation  of 
personality. 

As  an  illustration  of  the  transformation  effected,  I 
cake  at  random  the  following  extracts  from  some  of 
the  letters  written  to  me  by  patients  who  have  ex- 
perienced this  welling  up  of  reserve  energy:  "Indeed, 
were  I  to  fill  this  entire  sheet  with  expressions  of  the 
gratitude  which  wells  up  from  my  inmost  heart  it 
would  be  only  a  beginning  of  what  I  feel.  Surely  the 
darkness  of  the  world  has  been  dispelled  since  this  new 
light  has  illuminated  my  soul,  and  I  feel  that  this 
wondrous  light  will  never  fail  me.  It  were  vain  to 
attempt  to  thank  you  for  this  wonderful  transforma- 
tion. " 


404     Causation  and  Treatment^  Psychopathic  Diseases 

A  letter  from  a  patient  reads:  "You  will  be  glad  to 
know  that  all  is  well  with  me.  Life  is  one  happy  day. 
I  am  a  marvel  to  my  friends  in  the  way  of  happiness 
and  cheer.  I  have  to  confess  that  I  feel  almost  wicked 
to  be  so  happy." 

Another  letter  runs  as  follows :  "  Next  to  the  gladness 
in  my  own  restoration,  I  am  rejoiced  at  the  wonderful 
transformation  that  has  come  to  my  dear  friend  T. 
from  your  treatment.  She  writes  me  most  enthu- 
siastically of  her  steady  and  sure  progress  toward  the 
goal  of  perfect  health,  of  her  strength  to  take  up  the 
home  duties  which  had  been  so  burdensome  and  which 
she  now  finds  a  delight  in  the  doing  of  them;  and  of 
her  husband's  and  friends'  joy  in  the  transformation 
that  has  been  wrought  in  her." 

The  following  extract  from  a  letter,  written  to  me  by 
a  patient,  an  experienced  English  surgeon,  whose 
case  was  severe  and  chronic,  dating  from  early  child- 
hood, is  extremely  valuable,  both  on  account  of  his 
medical  training  and  mental  abilities  which  make  him 
an  excellent  judge  as  to  the  fundamental  change  and 
cure  effected: 

"It  is  now  exactly  two  years  since  I  was  undergoing 
treatment  at  your  kindly  and  sympathetic  hands.  I 
remember  that  you  once  told  me  that  the  seed  sown 
by  you  would  probably  take  this  length  of  time  to 
come  to  full  fruition.  Therefore,  it  may  not  be 
without  interest  to  you  to  receive  a  supplement  to 
many  other  letters  in  which  I  will  endeavor  to  sum- 
marise my  progress, — for  the  last  time. 

"I  have  no  longer  even  the  least  lingering  doubt 
that  you  can  count  me  among  your  most  brilliantly 
successful  cures.  I  say  this  after  many, — too  many 
heart  searchings  which  are  probably  characteristic 
of  my  somewhat  doubting  temperament.  At  first,  I 
was  disappointed  with  the  whole  business:  I  suppose  I 


The  Hypnoidal  State  and  Reserve  Energy        405 

looked  for  strange  and  dramatic  events  to  occur  which 
would  change  my  whole  personality  and  temperament 
in  a  short  time.  Nothing  so  exciting  happened :  I  left 
Portsmouth  still  feeling  that  I  owned  the  same  name, 
and  very  much  the  same  'ego'  that  I  arrived  with. 
I  was  unaware  that  any  profound  psychological  opera- 
tion had  taken  place.  To  be  candid,  I  did  not  think 
it  had, — the  beginnings,  no  doubt,  were  there, — but 
no  more.  But  now  when  I  carry  my  mind  back  to  the 
type  of  obsession  which  used  to  assail  me — Is  there 
any  change .''  Good  God !  I  behold  a  miracle,  although 
it  has  come  about  so  silently  that  I  can  only  realize 
the  difference  by  comparing  the  present  with  the  past. 

"In  conclusion  I  can  only  send  you  my  undying  and 
inexpressible  gratitude  .  .  .  You  have  saved  me 
from  what,  I  honestly  believe,  would  have  one  day 
resulted  in  deliberate  suicide  which  I  often  contem- 
plated as  the  one  solution  for  my  trouble".     .... 

These  extracts  are  typical  of  many  others,  and 
clearly  show  the  enjoyment  of  new  strength  and  powers 
until  now  unknown  to  the  patient.  Fresh  reservoirs 
of  reserve  energy  have  been  tapped  and  have  become 
available  in  an  hour  of  dire  need.  The  patient  has 
light  and  strength  where  there  were  darkness  and 
depression.  We  are  confronted  here  with  the  important 
phenomenon  of  liberation  of  dormant,  reserve  nergy. 
The  patient  feels  the  flood  of  fresh  energies  as  a  "mar- 
velous transformation,"  as  a  "new  light,"  as  a  "new 
life,"  as  a  something  "worth  far  more  than  life  itself." 

The  hypnoidal  state  helps  us  to  reach  the  inaccessible 
regions  of  dormant,  reserve  energy,  helps  to  break  down 
inhibitions,  to  liberate  reserve  energies  and  to  repair  the 
breaches  of  mental  life.  The  painful  systems  become 
dissociated,  disintegrated  and  again  transformed,  re- 
formed, and  redintegrated  into  new  systems  full  of 
energy  and  joy  of  life.       The  whole  process  is  one  of 


4o6     Causation  and   Treatment,  Psychopathic  Diseases 

disintegration  and  redintegration  with  the  awakening  of 
dormant,  reserve  energy. 

The  essential  condition  of  tlie  psychopathic,  of  the 
neurasthenic,  or  the  psychoasthenic,  of  all  the  various 
forms  of  recurrent  mental  states,  is  just  that  need  of 
putting  forth  energy  in  response  to  claims  of  life,  in 
response  to  stimuli  from  the  external  environment. 
The  creditors'  claims  cannot  be  satisfied  and  the 
individual  goes  into  insolvency,  in  spite  of  the  riches 
of  which  he  is  the  owner,  but  not  the  master.  He 
starves  in  the  midst  of  locked-up  plenty  of  which  he 
is  the  rightful  possessor.  In  other  words,  psychopathic 
patients  cannot  use  their  reserve  energy  at  the  critical  mo- 
ments of  life.  Excluded,  by  an  uncontrollable  and  intensi- 
fying fear  instinct,  from  the  enjoyment  of  what  Aris- 
totle and  the  ancient  Greeks  regarded  as  the  real  happi- 
ness of  man  namely,  "the  energy  of  exercising  the  soul 
according  to  reason,"  excluded  from  the  enjoyment  of 
self-activity  and  from  the  normal  exercise  of  powers  and 
functions  of  the  organism  as  a  whole,  the  patient  re- 
sorts to  sex,  drink,  drugs  and  other  stimulations  which 
may  temporarily  arouse  him,  calling  forth  fresh  re- 
serves of  the  ebbing,  vital  energy.  Such  stimulations 
by  the  pathological  processes  which  they  bring  about 
further  intensify  the  self-impulse,  increasing  the  terrors 
of  the  fear  instinct,  finally  resulting  in  complete  ex- 
haustion and  prostration,  with  all  the  accompanying 
psychopathic  symptoms.  Closed  against  the  voluntary 
control  of  the  psychopathic  individual,  the  energy,  the 
systems,  dissociated  by  the  great  rise  of  thresholds, 
can  be  awakened  to  spontaneous  activity  by  some 
accidentally  occurring,  appropriate  stimulation.  We 
find,  therefore,  in  psychopathies  a  diminution,  a  loss, 
an  inhibition  of  voluntary  activity  and  a  concomitant 
intensification  of  automatic  reactions.  Psychopathic 
states  are  characterized  by  paresis  or  paralysis  of  will 


The  Hypnoidal  State  and  Reserve  Energy       407 

and  by  predominance  of  automatism,  by  recurrent  mental- 
states,  or  by  recurrent  psycho-physiological  processes 
characteristic  of  the  psycho-biological  types  of  recur- 
rent   moments    consciousness.* 

We  find  in  psychopathic  states  a  weakening  or  even 
paralysis  of  the  higher  voluntary  functions  and  an  over- 
action  of  the  lower  automatic  functions.  The  weaken- 
ing or  paralysis  of  the  higher  psychic  functions  in 
psychopathic  states  is  not  due  to  deterioration,  but  to 
dissociation,  to  the  rise  of  thresholds  and  to  the  lock-up 
of  surplus  reserve  energy. 

The  value  of  the  hypnoidal  state  for  the  treatment 
of  psychopathic  affections  is  in  the  lowering  of  the 
high  thresholds,  and  in  the  formation  of  associations 
with  utilization  of  accumulated  stored-up  energy 
requisite  for  the  restoration  of  the  higher  psychic 
functions,  for  the  exercise  of  the  voluntary  and  personal 
control  over  the  dissociated,  automatically  or  sub- 
consciously functioning  groups  of  systems.  The  hyp- 
noidal state  is  essentially  a  primitive  rest-state  and  has 
been  utilized  almost  from  the  very  origin  of  animal 
life  for  the  repair  and  restoration  of  worn-out  organs 
and  impaired  functions.  Unlike  the  waking  state,  the 
hypnoidal  state  does  not  present  any  special  adaptations 
to  the  external  environment.  The  only  use  of  the 
hypnoidal  state  is  repair  of  impaired  functions  and 
utilization  of  fresh  energies.  We  can  still  use  the 
hypnoidal  state  for  the  same  purpose. 

The  rigidity  of  group  associations,  requisite  in  the 
struggle  for  existence,  gives  way  in  the  hypnoidal  state. 
In  the  subwaking  state  there  is  a  reduction,  a  redis- 
tribution and  fall  of  thresholds,  with  a  consequent 
potential  reformation  and  recombination  of  systems 
into  new  groups  and  aggregates.  The  hypnoidal  states 
may     be     taken     to     represent     an     indifferent    or 

*See  The  Foundations,  Part  II,  Chapter  II, 


4o8     Causation  and   Treatment^  Psychopathic  Diseases 

neutral,  mental,  psychophysiological  equilibrium.  We 
can  utilize  this  primitive  state  to  bring  about  a 
more  favorable  change  in  the  disturbed  equilbrium  of 
the  narrowed,  dissociated,  impoverished,  enfeebled 
and  full  of  automatism,  degraded,  waking  life. 

The  overacting  dissociated  systems  with  their  auto- 
matic reflex  reactions  may  form  associations  with 
other  systems,  and  thus  become  inhibited  as  well  as 
controlled  in  their  function  by  the  voluntary  activity 
of  personal  consciousness,  while  the  inhibited  systems 
with  their  raised  thresholds  and  accumulated  reserve 
energy  are  set  into  function.  It  is,  therefore,  possible 
to  bring  about  a  greater  vigor  of  personal  activity,  a 
more  efficient  control  of  reactions  to  stimulations,  a 
better  adjustment  of  the  organism  to  the  conditions 
of  its  environment.  It  is  by  means  of  such  readjust- 
ment of  disturbed  psycho-physiological  reactions  that 
psychopathic  affections  are  restored  to  normal  function- 
ing, and  thus  get  cured  in  the  subconscious,  subwaking, 
hypnoidal  state. 

The  pathology  of  psychopathic  maladies  is  essentially 
a  morbid  state  of  the  impulse  of  self-preservation  with 
its  accompanying  fear  instinct.  We  cannot  help 
agreeing  with  Mosso  that  "fear  is  a  disease  to  be 
cured."  Psychopathic  maladies  are  curable  and  pre- 
ventable. The  practical  aim  of  Psychopathology  is 
the  complete  eradication  and  prevention  of  psycho- 
pathic diseases. 


INDEX 


Aberration,  mental,  27 

of  self-consciousness,  346 

Abnormal    mental     life,    81 
suggestibility,    38,    364, 

365 
Accumulative  moment,  75 

Activity,  cellular,  27 
neuron,  130 
Adrenal  secretion,  63 
Affection,   cardiac,    360 

etiology  of,  26 

psychopathic,  54,  55,  56, 

57,  58,  127,  184 
Affective  elements,  351 
Aggregate  of  moments,   75, 
82,  84 
neurons,  339 
psychopathic,  69,  70,  71, 

72,    112 
social,  161 
Agoraphobia,    37,    169,    181, 

182 
Aichmophobia,  37 
Ailurophobia,  182 
Aim  of  psychopathology,  408 
Alcoholism,    391,    392,    393, 

394 
Alternation,     emotional,     65 
Amnesia,  77,  79 
Anabolic  activity,  403 

process,  341 

stage,  4CXD 
Anabolism,  mental,  332 
Analysis,   sexual,  338 
Angina  pectoris,  58 
Anguish,  90 
Animal  instincts,  346 
Antagonism,  mental,  334 


Antagonistic    reactions,    334 
Anthropology,  vi 
Anxiety,  33,  34,  38,  43, 46, 50, 
62,  67,  262 

precordial,  50 

states,  70 
Aphasia,    motor,    181 
Arbitrary  meaning,  238 
Archoplasmic  structures,  355 
Aristotle,  406 
Arndt,  63 

Arteriosclerosis,  181 
Arthorpoda,  353 
Assimilations,  law  of,  249 
Associated  systems,  396 
Associations,    70,    354,    400 

indirect,  347 

sexual,  24,  27,  32,  37,  80, 
.338,354,368,400,402 
Associative  activity,  25 

life,  133 
Asthenopia,  137 
Asthma, psychopathic,     179 

181 
Astrophobia,  37 
Atavism,  336,  356, 
Atavistic  states,  66 
Athletic  treatment,  360 
Atrophy  of  function,  95 
Attention,  374,  375 

concentration  of,  138 

distraction  of,  91 

fixity  of,  38 
Automatic,  74,  84 
Automatism,    91,    340,    342, 

406,   407,   408 
Auto-toxic  products,  27 


409 


4IO 


Index 


Babkin,  63,  399 

Bacon,  42,  90 

Bain,  34,  39,  54 

Basis  of  psychopathies,     223 

Bechterev,  51 

Belief,  eugenic,  v 

Bidder,  21 

Biological  law,   356 

phenomenon,  356 
Biology,  IV 
Blood  pressure,  160 
Brain,  fatigue,  361 

sclerosis  of,  140 
Breakdown,  nervous,  145 
Brooding,  208,  216,  217,  224, 

346 
Brooks,  35 

Cannon,  63 

Cardiac  affection,  360 

Carlyle,  344 

Catalepsy,  266 

Causation  of  psychopathies, 

184 
Causation    of    subconscious 

states,  38,  41,  53,  57,  62 
Cellular  activity,  27,  132 

nutrition,  26 
Central  elements,  121 

exhaustion,  140,  361 

nervous  system,  21 

overstrain,  143 
Character,    egocentric,    iii, 

116 
Chemical  moment,  22 
Child  experiences,  66 

life,  X 
Childhood,    62,    63,    74,   93, 
114,     123,     124,    172, 
184,    186,    200,    220,    235, 
260,  274,  279,  318 
Chromatin,  v 
Civilization,  i,  11,  v,  36,  46 


Classification  of  diseases,  26, 

28 
Claude  Bernard,  21 
Claustrophobia,  37 
Cognitive  states,  66 
Compayre,  59 

Complex    nervous    organiza- 
tion, III 
Conditional    reflex,    22,    25, 

37,  53,  396,  397,.  399 
Conditions  of  suggestibility, 

40,  364,  365,  374 
Conscious  moment,  23,  75,  79 
Consciousness,  38,  66,  73,  74, 

77,  79,  184,  400 
disaggregation  of,  38,  84 
Constellation,  81 
Construction  of  personality, 

333 

Contrast,  emotional,  66 
emotions,  66 

Control,  of  births,  vi 
principles  of,  65 

Course  of  treatment,  331 

Craving  for  stimulations,  135 

Crile,  48,  51,  59,  133 

Critical  moments,  406 

Curari,  355 

Custom,  342 

Cyclical    movement  of   mo- 
ment, 80 

Cytoplasm,  27,  133 

Darwin,  21,   33,   35,   50,   54 
Death,  fear  of,  166 
Degeneration,  process  of,  81, 

83 
Dejerine,  359 
Demoor,  95 
Depressants,  27 
Desultory  moment,  75 
Deviations,  psychopathic,  iv 


Index 


411 


Diagnosis    of     psychopathic 

maladies,  184 
Differentiation     of     psycho- 
pathic affections,    31 
Direct  suggestion,  336 
Disaggregation  of  conscious- 
ness, 38,  84 
Disaggregative  moment,  81 
Diseased  personality,  344 
Diseases,  classifications  of,  26 
28, 

functional  and  nervous    27 
Disintegration,    cellular,    27, 
132 

method  of,  335 
Dissociation,    38,     132,    368 

mental,  81 

principles  of,  67 
Distraction  of    attention,  91 
Dominance,  principle  of,  68 
Donley,  J.,  368 
Dormant  energy,  400,  403 

systems,  403 
Dream  consciousness,  80 

life,  260 
Dreams,  229,  230 
Drug  habits,  373 
Dynamic   energy,    129,    131, 

133,  135 
Dynamogenesis,  principle  of 

68,  338,  339 
Dyspnoea,  197,  198 

Education,  i,  137,   356 
Efficiency,  v 
Egocentric,  348 

character,  iii,  116 
Egotism,    psychopathic,  116, 

121,  127 
Elements,  affective,  351 

afferent,  350,  351 

central,  33,  351 

efferent,  350,  351 


motor,  351,  352 

primary  and    secondary, 
80 

psychomotor,  356 

recessive,  68 

sensory,  350,  351 
Embryonic  type,  356 
Emotional  contrast,  66 
Emotions,  63,  349,  380,  381, 

382 
Energid,  129 
Energy,    54,    135,    138,    340 

dynamic,  129 

kinetic,  402 

liberation    of,    130,  405, 
406 

static,  129 
Environment,  11 
Epicurus,  343 
Epilepsy,    36 

hystero,  38,  381 

Jacksonian,  254 

larval,  23 

psychic,  356 
Equilibrium  of  neuron  aggre- 
gates, 340 
Ergograph,  160 
Etiology  of  neurosis,  179 
Evolution,  psychopathic,  72 

Fading  moments,  73 

process,  76 
False  recognition,  231 
Fatigue,  no,  136,  137,  144, 
151,  155,  156,360,366 
cerebral,  360,  361 
fear,  144,  145 
Fear,  33,  34,  35,  37,  39,  43, 
46,  48,  so,  63,  68,  85, 
93,  120,  123,  133,  134, 
145,  162,  280 


412 


Index 


Fear,  of  death,  i66 

instinct,  33,  37,  39,  40, 
41,  43,  44,  47,  50,  SI, 
52,  51,  54,  57,  59,  62, 
63,  64,  69,  86,  87,  88, 
96,  III,  116,  119,  122, 
144,    163,    186,    246, 

342 

nucleus,  69 

testing,  342 
Feeling  of  excitement,  65 
Field  of  attention,  334 
Fixation  of  attention,  38 
Focus  of  consciousness,  79 
Food  reactions,  83 
Frazer,  36 
Functional  psychoses,  iv,  32, 

41,  52 
trauma,  402 
Functions,  law  of,  95 
Furies,  psychopathic,  128 

Galvanic  reflex,  399 

Genesisofpsycho-neurosis,249 

Germ-plasms,  v 

Germs,  psychopathic,  224 

Giddings,  161 

Glandular  secretions,   63 

Glycosuria,  63 

Goitre,  exophthalmic,  49 

Goltz,  51 

Grave's  disease,  49 

Group  of  systems,  399,  400 

Gynophobia,  270 

Habits,  83,  84 

psychopathic,  341 
Habit-tics,  270 
Haller,  50 
Hallucinations,   80,   257 

Happiness,    psychopathic, 
99,  100,  121,  134 


Health,  psychopathic,  95,  97, 

115,  121,  124,  345 
Heart  affection,  142 
Hematophobia,  182 
Hemicrania,  266 
Hemiplegia,  181 
Heredity,  i,  iv,  v,  vi 
Hierarchy   of    moments,    73 
High  types  of  moments,  82 
Homicidal  impulse,  78 
Homosexuality,  380,  381 
Human  personality,  194 
Hypertrophied  fear  instinct 

69 
Hypertrophy  of  self-preserva- 
tion, 96 
Hypnoidal,  method,  210 

states,  74,  204,  206,  218, 
246,    269,    347,    363, 
364,    367,    370,    372, 
374,  375,  407 
Hypnoidic  states,  74 
Hypnoidizations,     184,    362, 
364,365,367,368,370 
Hypnonergic  states,  jj 
Hypnosis,   73,   77,   266,   363 
Hysteria,  23,  137 
Hystero-epilepsy,  23 

Ideas,  imperative,  78 
Ideo-motor  life,  351 
Ideo- sensory  stimulations,  21 
Imperative  impulses,  29,  78 
Impulse  of  self-preservation, 
85,    86,   90,   96,    116, 
119, 122,  127, 162,  186, 
194,  246,  342 
Impulses,  homicidal,  78 

suicidal,  78 
Impulsiveness,  339 
Indirect  association,   347 
suggestion,    method    of, 
336,  347 


Index 


413 


Inhibition,  22,  25,  38,  70,  90, 
132,188,375,396,397, 

39?,^  399,  402,  403 

conditional,  398 

principle  of,  69 
Inhibitory  stage,  396 
Insomnia,  89,  142,  143,  144, 

152,  15s 
Instinct,  349 

nature  of,  349 

organized,  82 

of   reproduction,    96 

sex,  82 
Integration,  method  of,  340 
Intelligence,      psychopathic, 

358 
Intensity    of    psychosis,    73 

Interest,     psychopathic,  96 

Intermediary  stages,  75,  76, 

78,  80 

Interpretation,     method  of, 

.  336 
Irradiation,   principle  of,   67 

Jacksonian  epilepsy,   254 
James,  33,  68,  129 
Janet,  201,  216 
Jukes,  the,  vi 

Kinaesthetic  associations, 

357 

memories,  354,  357 

sensations,  357 

sensibilities,  355 
Kinetic  energy,  402 
Kinocentre,  355 
Kinoplasm,  355 
Kirchoff,  45,  51 
Kraepelin,  46,  51 

Labile  elements  of  conscious- 
ness, 3  56 
Lack  of  confidence,  344 


Larval  epilepsy,  340 

Latent  energy,  69 

Law  of  assimilation,  249 

Law,  biological,  356 
of  contrast,  66 
of  disaggregation,  82,  84 
of  function,  95 
of  geometrical    progres- 
sion 162 
of  modifiability,  72 
of  moment  degeneration 

82,  187 
of  moment  reversion,  80 
of  recession,  73,  187 
of  reversion,  76,  80,  187 
social,  27,  161,  162 
of  suggestibility,  364,  365 

Legislation,  eugenic,  vi 

Liberation     of    energy,     130 
of  reserve   energy,   405, 
406 

Life,  abnormal,  81 
dream,  260 

Limitations, psychopathic,345 
of  self,  346 

Logical  activities,  358 

Loss  of  personality,  199 

Lotzko,  51 

Low  types  of  moments,   82 

Lucretius,  344 

Magic,     psychopathic,     348, 

349 

Mal-adjustment,  348 

Malthusian  control  of  birth,  vi 

Manic-depressive   psychoses, 
66 

Manifestation     of      psycho- 
pathic maladies,  55 

Meaning,  arbitrary,  238 

psychopathic,    336,    337 
of  symptoms,  336,  337 


414 


Index 


Measures,  eugenic,  vii 
Melancholia,  83 
Meltzer,   401 
Memories,  kinaesthetic,  354, 

356 
Memory,   77,    139,   204,   355 
Mendelian  terms,  66 
Mental  aberration,  27 

activity,  352 

alienation,  83 

alternations,  66 

anabolism,  332 

antagonism,  334 

defectives,  357 

dissociation,  81 
Metamorphosis   of   fear,    69 
Metathesis,   method  of,   334 
Method    of    conditional    re- 
flexes, 22 

of    disintegration,    335, 

337 
of  eugenists,  vii 
hypnoidal,  210 
of    indirect    suggestion, 

347 
of  integration,  340 
of  metathesis,  334 
psychognostic,  184 
psychotherapeutic,  332 
of  synthesis,  340 

Methods    of    direct    associa- 
tion,   347 
indirect  associations  347 

Minds,   unstable,   in 

Minot,  C.  S.,  401 

Mishtovt,  32 

Mitchell,  371 

Modifiiability,     of    elements, 
380,  381,382 
law  of,  72 

Moment,    accumulative,   73, 
75,.82 
chemical,  22 
consciousness,  23 


cyclical  movement  of,  80 

degeneration,  law  of,  82, 
187 

desultory,   75 

outlived,  73 

reversions,    law    of,    80 

subconscious,   79 
Monotony,  38,   135 
Montaigne,  43 
Moral  life,  83 

Mosso,  IV,  50,  62,  136,  137 
Motor  elements,    355 

_  memories,  354,  355 
Multiple  personality,  57 
Mysophobia,  175 

Narcosis,  84 

Natural  selection,  132 

Nature  of  instinct,  349 

Necropathies,  26,  27,  28,  132 

Neophobia,  342 

Nervous  breakdown,  145 

energy,  54,  129 

system,    central,    21 
Neurasthenia,  23,  142 
Neuron  activity,    130 

aggregate,  339 

complex.  III 

energy,    129,    135,    339, 

340 
Neuropathies,    26,    28,    129, 

132 
Neuro-psychosis,  31,  32 
Neurosis,  69 

acquired,  ix 
functional,  x 
hereditary,  ix 
Neurotic  affections,  etiology 

of,  26 
Non-fulfillment  of  desire,  66 
Nucleus,  primordial,  71 

psychopathic,  71,  72,  335 
Nutrition,  cellular,  27 


Index 


415 


Obsession,  29,  31,  62,  65,  70, 

121 
Occasions,  psychopathic,  163 
Omens,  237,  238,  268 
Omen  testing,  223 
Ontogenesis,  82 
Ontogenetic       development, 

350 
Oppenheim,  45,  51 
Orbeli,  22,  24,  63,  398 
Organic  diseases,  26 

energy,  130 
Organopathies,  26,   129 
Ornithophobia,  179 
OutHved  moments,  73 
Over-fatigue,  359 

Panophobia,   256,   257,   262, 

270 
Paralysis  of  will,  406,  407 
Paranoia,  83 
Paranoidal  aspect,  116 
Parasitic  egotism,  127 
Parasitism,  95 

Pathological  focus,  69 

processes,  27,  91 
Pathology       of       functional 
diseases,  27 

of  psychopathic  diseases, 
85,  408 
Pathophobia,   loi,   125,   176, 

177 
Pavloff,  21,  22,  24,  25,  37,  53 
Periodicity  of  function,    339 
Periods  of  activity,  362 

of  repose,  362 

of  trauma,  288 
Peripheral   exhaustion,     361 
Personality,  construction  of, 

333 
embryonic,  39 
loss  of,  199 


reformed,  403 

Phobia,  46 

Phrenophobia,  loi,  176,  200 

Phylogenesis,  82 

Phylogenetic  evolutions,  350 

Pinel,  139 

Plasticity  of  nervous  system, 
25,  408 

Pneumo-gastric  nerve,  21 

Polyuria,  47 

Potamophobia,   179 

Predisposition,  vii,  viii 

Pressure,  blood,  160 

Primary       and       secondary 
elements,  80 

Prince,  Morton,  199,  201 

Principles,    of    complication, 
64,  187 
of  control,  65 
of  differentiations,  67, 187 
of  diffusion,  67,  187 
of  diminishing  resistance, 

69,  187 
of  dissociation,  66,  187 
of  dominance,  68,  187 
of  dynamogenesis,  68, 

338,  339,  3.40 
of    embryonic     psycho- 
genesis,  64,  187 
of  fusion,  65,  187 
of  inhibition,  69,  187,  396 
of  irradiation,  66,  187 
of    metathesis,     70,    71, 

187,  350  . 
of  modification,  350,  358 
of  proliferation,  64,  187 
of  recession,  66,  187 
of  recurrence,  64,   187 
of  reserve    energy,    129, 

391 
of  synthesis,  65,  187,340 

of  variations   of   neuron 

energy,  186 


4i6 


Index 


Process  of  association,  8i,  82 
degeneration,  27,  84,  85 
disaggregation,  81 
reduction,  75 
Products,  auto-toxic,  27 
Psychic,   compound,   53 
epilepsy,   356 
moment,  22 
Psychoasthenia,  23 
Psychogenesis,    37,    64,    333 
Psychogenetic     examination, 

Psychognosis,  51,  70,  71,  72, 

136,  184,  196,  363 
Psychognostic  method,  184 
Psychoneurosis,    28,    29,    30, 
31,  32,  36,  57,  58,  90, 
163,  331,  333 
Psychoneurotic,    185 

affections,  57 
Psychopathic   aggregate,   69, 
70,    72,    112 
deviations,  iv 
diseases,  33,  43,  47,  163 
Psychopathic  furies,   128 
germs,  224 
happiness,  99,  loi 
health,  95,  97,  115,  121 

124,  345 
interests,  96 
maladies,   184 
manifestations,  55 
states,  38,  58,  64,  67 
systems,  72 
Psychopathies,  23,  24,  28,  30, 
36,  52,   129,   132 
basis  of,  223 
causation  of,   184 
Psychopathological    princi- 
ples, 72 
Psychopathology  of  neurosis. 

Psycho-physiological  equilib- 


rium, 408 
Psychosis,  functional,  iv,  32, 

41,   52 
Psychosomatic,   185 
Psychotherapeutic,  methods, 

332, 
standpoint,  72 
Psychotherapy,  332,335,  338, 

362 

Quack  literature,  164 
Quadrumana,   353 
Quality  of  feeling,  71 
Quest  of  health,  126 

Reaction  time,  399 
Reactions,  24,  25 
Recall,  354 
Recession,  law  of  73,  187 

principles  of,  66 
Recessive  elements,  68 
Recurrence,  64 
Recurrent,  mental  states,  23, 
179 

moment,  343 
Redintegration  of  energy,  406 
Reductive  mass,  339 
Reflex  consciousness,  365 
Reflexes,  conditional,  22,  25, 

37,  53,  397,  399 

galvanic,  399 
Reformed  personality,  403 
Relaxation,  366,  368 
Reserve   energy,    131,    132 

neuron  energy,  368,  369, 
400 

power,  401 
Rest-cure,  346 
Restitution    of    energy,    131 
Reversion,  law  of  76,  80,  187 
Ribakov,   179 
Richet,  21 
Romanes,  35,  40 


Index 


417 


Routine,  342,  343 
Rudimentary   organs,   356 

Sachs,  129 

Savadsky,   22,   63,   396,   397 

Schmidt,  21 

Schopenhauer,  98 

Schultze,  63 

Sclerosis  of  brain,  140 

Seclusion  method,  360 

Secondary  dementia,  84 

Secretion,  abnormal,  63 

glandular,  63 
Selection,  social,  i 
Self-aggrandizement,   116 

analysis,  375 

love,  99 

pity,  347. 

preservation,  34,  86,  88, 
90,  96,  III,  116,  119, 
122,  127,  162,  186, 
194,  246,  342,  349 

regard,  66 
Selfishness,  psychopathic,  86, 

_    87,  88,  118,  347 
Sensibility  of  nervous  organ- 
ization, III 
Sensorium,  21 
Sex,  instinct,  82,  338 

reactions,  83 
Sexual  analysis,  338 

association,    347 

interest,  96 

life,  58 
Sherrington,  24,  63 
Signal  of  unreality,  398 
Sleeping  states,  131,  372 
Social  aggregate,   161 

law  of,  27,   161,   162 

panic,  161 

reaction,  83 
Somatopsychosis,  28,  30,  36, 
57,  58,  90,   163,  331, 


Sphygmograph,  160 

Spinoza,  343 

Stability  of  moments,  84 

Stanley  Hall,   51 

Stage  of  excitement,  27 

States,  cognitive,  66 

hypnoidal,  74,  204,  206, 

218,    246,    269,    347, 

363,    364,    367,    370, 

372,   374,   375 
Static  energy,   129,   130,   134 

Stimulants,  27 

Stimulations,  ideo-sensory,  21 

Stimulus  threshold,  400 

Subconscious    associations, 

372 

dream  life,  260 

experiences,  372 

moments,  79 

regeneration,  73,  74,  76, 
78,  79,  80 

self,  161 

shocks,  IV 

states,  causation  of,  38, 

41,  53,  57,  62 
systems,  69,  333 

Subconsciousness,  90,  185 

Suggestibility,  163 

Suggestion,   357 

Sully,_  34,  41 

Superior  races,  v 

Sympathy,  psychopathic,  87, 

89,  97,  135 
Symptoms,  meaning  of,  336, 

337 
Synthesis,    principle     of,    65 
of  psychopathic  aggregates, 

69 
Synthetic  methods,  340 
Systems,   dormant,  403 


41 8 


Index 


Table  of  suggestibility,    364 

Taboos,  social,  59 

Temperament,   185,  220 

Test-dream,  230 

Testing,  223,  226,  227,  228, 
237,  239,  242 

Theory  of  reserve  energy,  402 

Thresholds,  131,  396,  399402, 
rise  of,  400 
systems,  399,  407 

Tics,  270 

Tradition,  342 

Trance    states,  77,  347 

Transformation  of  personal- 
ity, 335,  403,  404,  405 

Treatment,    184,    331,    333, 
346,  350,  358 
hypnoidal,  150,  377,  378, 
_   381,383,384,386,387 

Tropisms,  349 

Twilight  states,  363 

Types   of   organization,    349 

Ultimate  fear  states,  67 
Unconditional    reflexes,     22, 

398 
Uncontrollable  impulses,  78,79 


obsessions,  70 
Unification  of  consciousness, 

365 
Unreality,  signal  of,  398 
Unstable  minds,  iii 

Vanity,  psychopathic,  87,  98, 

112 
Variability,  354 
Vasiliev,  23,  63,  396,  398 
Vaso-motor  systems,   21,   54 
Visceral  functions,  21,  23 
Vividness  of  consciousness,  73 
Voluntary  activity,  354 

association,  66 

control,  66 

Waking  states,  131,  364 
War,  European,  44 
Weak  nerves,   i 
Weir  Mitchell,  126,  155 

treatment,  358,  359 
Will,   349,   400 

paralysis  of,  406,  407 

psychopathic,  88 
Wishes,    psychopathic,     136 


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